Eat These Probiotic-Rich Foods To STAY HEALTHY Until You're 100+ Years Old! | Mark Hyman

So if you have a bad gut, if you have a leaky gut, if you're eating the wrong foods, it's going to create more insulin resistance, create more weight gain, create more belly fat and a vicious cycle.

Mark, I'm going to take you big picture and just say, why do we need probiotics in the first place? And when was the first time that you encountered in your journey and even heard the term probiotic?

Oh, wow. I mean, first of all, probiotics are exactly what they sound like. They're pro biotics, as opposed to antibiotics. They help produce a healthier gut by giving the gut the good bugs in.

It that it needs to thrive.

And I first discovered them probably back in, God, the beginning of my career as a doctor and began to know about them through learning about nutrition and the role of the gut way back 30 plus years ago. and studying functional medicine, they became just very obvious to me that they were critical components of rebuilding gut and rebuilding health for so many patients. So they have been using them and experimenting with different probiotics over decades and decades. And I learned so much about what they do, their role, why they're important, how they work, how they don't work, which ones are good, which ones are bad. And it's just a, it's a little bit overwhelming out there for people to figure out, what do I take? And which one do I take? And is it cold or in the fridge, can it be on the shelf? What do I take for this condition, for that condition? And they're varied because there's literally thousands of different microbes and they all have different roles, they all do different things, and they all have different benefits. So it's really about customizing and personalizing, but there are some basic ones that have really important functions and we're going to talk about that.

And you went through the whole backstory in the last masterclass that we did on polyphenols, but just high level, what are the top insults that are going on in this world that we live in today that are destroying the microbiome and putting us in a place where we even need to be thinking about probiotics.

Yeah, I mean, just briefly, we live in a gut-busting world. I mean, our hybridized processed, high sugar, high starch diet, low fiber, low polyphenol diet is a disaster for the gut. So, it's a perfect storm for creating bad bugs. Second, we know we're born by C-sections, we don't breastfeed as much, we get early antibiotics, we use all kinds of drugs that screw up the gut from acid blockers to anti-inflammatories to the pill. or birth control, and all that is a perfect storm. On top of that, you've got all the ingredients in processed food like carrageenan and gums and emulsifiers that further damage the gut and cause leaky gut. And, if that were enough, our food is often filled with pesticides and herbicides, glyphosate, for example, which is a microbiome destroyer. So, we basically live in a gut-busting world and we have to be very vigilant about keeping our gut healthy, even.

If we don't have gut symptoms. So, one of the first questions that people had, Mark, on this topic of probiotics is store-bought probiotics and things like kombucha and probiotic beverages, are they actually healthy and can they be beneficial to people?

Yeah, so let's just take kombucha because that's the kind of big craze and I'll go down the other ones. I mean, kombucha is great for a lot of people. It can be fine. It's a bubbly drink. It tastes good. It actually has probiotics in it. It can be beneficial, but a lot of them also are loaded with sugar.

So that's most of them.

Yeah. So, I mean, without them, they taste pretty bad. Without sugar, it tastes pretty bad. So I, I kind of not a huge fan. I think for the right person, it can be fine. And if your guts pretty healthy, it can be fine. But if you are struggling with weight, if you have blood sugar issues or a lot of overgrowth or yeast problems, it can be problematic because the sugar.

Is going to feed the bad bacteria. And on top of that, liquid calories are some of the most destructive when it comes to metabolic Health.

Sure, right. So you don't want to drink your calories. And as far as probiotic beverages, they're little kind of bottles of probiotics. They can be very good and helpful and I think they're not bad to try and take. And there's a lot of probiotics in the refrigerated sections of a lot of health food stores and grocery stores and there's a lot to choose from and people are kind of confused about which one should I take for what. There are also probiotics that are ones that are in pharmacies like Lactobacillus GG or Align that are more commercially available probiotics that have been well studied for treating different conditions. So, there's a lot out there. I think we have to look carefully at what's in them and there's a lot of sugar, how long have they been there, what does it say on the bottle? A lot of times you look at the bottle and says 50 billion colony forming units, but then when you actually do look at it, they degrade very fast, they may not have what is in there. So, quality matters. brand matters, how it's stored matters. And I think that's a little bit of a kind of crapshoot when you go trying to look for this stuff in the store.

So Mark, take us a little bit deeper, really on the topic of like why do we need probiotics and how can they be beneficial? Like what are actually the things that they make a difference on when it comes to our health?

Yeah, so thank God we're in this era of microbiome research. 'Cause we know now from many, many studies from many different strains of probiotics, all the beneficial effects that they have. And we're still learning more and how to develop more and better probiotics. So we're growing fast in this knowledge base. But probiotics essentially are modulators of intestinal function. So they will change the immune function, they'll change the cell signaling communications, they'll compete with other bacteria that are bad bugs and get rid of those, they'll compete with yeast and help reduce those by actually helping promote more of the good bugs. They tend to be tourists. They don't exactly colonize most of the time, although they can. So, they don't stay forever, but as long as you're taking them, they do their work. And then, they have all these inflammatory things that they do that are anti-inflammatory. They actually help you build digestive components that actually help creating vitamin K and biotin and other nutrients that your body needs. They're helping break down foods that you can they're helping create short-chain fatty acids. So, they really change the whole ecosystem of the gut. And, it's so important because if your inner garden is unhealthy, for most of us it is, then you're more likely to get not only digestive symptoms like irritable bowel and reflux and inflammatory bowel disease, but you're more likely to gain weight, get diabetes, have allergies, have asthma, have autoimmune diseases, have depression, anxiety, ADD, dementia, and a lot of other things when your gut's not working. So, you know, we're, we're, we do all the things that are really bad for our gut and even our stress is bad for our gut. Alcohol is bad for our gut. All these drugs that we take are bad for our gut. And so we live, we live in a culture where we really double down on, on focusing on gut health. And, and to date, we really haven't had a way to do that. I mean, yes, take this probiotic or this probiotic, but we've created a multivitamin for the gut, which really puts together all the key components, prebiotics, probiotics and polyphenols that the gut needs to create a healthy inner garden. And, I think when we get off of the processed food, when we get off of the gut-busting drugs, when we start to take probiotics, when we start to take gut healing compounds that are in gut food in our multivitamin for the gut, we can really start to help rejuvenate and rebuild the gut, which then has all these downstream consequences of improving your immune system, improving your mood, improving your metabolism, reducing inflammation in the body. It's really what we want to be doing. And, when you look at some of the data, and we have really good data on the product that's in our formula called LactoSpore. LactoSpore is a spore-based probiotic. And when they did clinical trials, a pilot study, but it was a randomized controlled trial, they found a 42% reduction in bloating and irritable bowel, a 47% reduction in vomiting, a 43% reduction in diarrhea, and a 68% reduction in pain. And even more remarkably, they looked at what happened to the the brain, because how is the gut and the brain connected? Well, they are very connected through the gut-brain connection. And depression went down 57%. Sleep got better, 58%. Dementia symptoms went down 26%. Quality of life went up 47%, along with GI discomfort going down by 62%. That's amazing, just from a probiotic, right? So, you know, there are a lot of ones on the market out there. This one's shelf stable, so you don't have to refrigerate it. which is a big deal, being able to travel with it. And two, it's one that is a very unique form called Bacillus Coagulans that has all these benefits. Not all probiotics are the same and not all have these benefits, but this one is really well studied and actually has these incredible benefits. Yeah, and what's great about the formula.

Is that it's the levels shown in the clinical trial, which we'll have the links to those below, that is the same level that's placed inside the formula. Now, we're not just here to talk about the new formula that you put together, Gut Food. you've been using probiotics as part of your protocols that you've written in your book for a really long time. And one of the great things is that there's a lot of really great companies. A lot of we call them the doctor's brains, Metagenics, Designs for Health, Thorne, Claire Labs, I'm leaving out a few Pure Encapsulations. They have been some of the most incredible brands and many others in that ecosystem that have really touted the benefits and educated many practitioners like yourself about how different strains of probiotics could be used to deal with patients who are struggling with various sorts of things. Is there an example, not that you have to mention a particular product, but is there an example sometimes where you might bring in a particular strain of a probiotic because it's been shown to do really well for a patient that has a specific condition?

I mean, one I like to use is really great is called Saccharomyces boulardii, which is not actually a bacteria, it's a yeast, but it's called off in yeast against yeast. But, it has a profound effects in regulating not only biofilm in your gut controlling yeast overgrowth, but also helping with the deal with chronic gut issues like clostridia like I had. So, it's shown that if you take this particular strain, it helps reduce the symptoms or even get rid of clostridia bacteria, which is really great. So, I really am very focused on which ones do what. Some of them are-- by the way.

If you go to PubMed and you type in Saccharomyces boulardii, there's a ton of research on also diarrhea. Yeah, diarrhea, right. People who get to go to India and they get like Delhi belly or they go to Mexico and they get Montezuma's Revenge or whatever, you know, people are calling it. Saccharomyces is one of the things that people are given to help them deal with some of the stomach upset that comes from just being introduced to bacteria.

That they may not typically be introduced to. Absolutely. And then there's different bacteria for different things. For example, for babies, you know, often there's a particular bacteria called Bifidobacterium infantis. It's really important for immune development. And it's absent in most babies because the mothers have had an antibiotic sometime in their life and wiped that out or they're born by C-section. And the 25% of calories that's in breast milk that's not digestible by babies is there to feed this particular bacteria and others called Bifidobacterium infantis. And if you have low levels, it's a big problem. So you can actually give the baby probiotics when they're born in the first hundred days to help them colonize with Bifidobacterium infantis and avoid the autoimmunity, the allergy, the eczema, and all these other downstream things that are going to happen if you don't have this important bacteria. So, that's just another example of how.

Different strains do different things. Yeah, and just a little shout out. They were on your podcast previously, the name of the company that is- Evivo. Evivo. Yeah, they're doing some really game changing space stuff in the space. And, there's plenty of others. There's our friends, Kieran at Microbiome Labs. There's some friends that you're connected with at Seed that are also doing some amazing things. It really does feel like we're in this sort of golden age of people really starting to put the emphasis about on probiotics. And it's less about the competition between all these different people and more about the awareness because we need a lot of different solutions for people at different levels. And we may be getting to a point soon where we get personalized probiotics.

Where-- that'd be very interesting. You look at your microbiome and we look at what's there, what's not there. And I do this now. I say, oh, you don't have enough of this or that, so I'm going to fix this or that. So I do that. but we're gonna be more sophisticated about it and be able to make custom probiotics for people.

And you talked about this a little bit before, but there's so many Instagram ads and TikTok ads that I get which are like, Hey, we'll tell you exactly the diet and the probiotics to take based on your stool. So send in your stool and let's tell us. You chatted a little bit about this.

In the past, but just talk about how we're getting there, but maybe not yet. Yeah, we're getting there. I think there's sometimes overreach and overpromising and under delivering on some of these tests. and they don't take into context the patient's overall health, the other parts of their digestive function. They just look at the actual bacteria and they make all these conclusions based on the science, but that can be a lot of noise too and not actually helpful for people. So I think it's important to learn about yourself, to do the testing, but take with a grain of salt a lot of the recommendations that are happening now. You wanna try stuff and see how it works, but you don't wanna think.

Of it as the gospel. So one of the things we wanna chat about when it comes to eating probiotic rich foods which also includes some prebiotics in there as well. We'll do a whole another episode on prebiotics. So the research shows that eating a high fermented food diet increases diversity in the microbiome and decreases inflammatory markers. So the question is what are some examples of some of the top fermented foods that many people can include on a daily basis to tap into some of these benefits that the research is showing?

Yeah, absolutely. I think historically We didn't have refrigerators. And as a species, we really got good at preserving food. And we did that through making cheese or through drying meat or through creating fermented foods. And these cultures have had these for thousands of years.

Which, by the way, is another form of cooking.

Yeah, exactly. So sauerkraut, kimchi, pickles, miso, natto, tempe, kefir, yogurt, these are all forms of bacterially generated food substances that actually are full of these beneficial compounds. And, there's a great study, I love this one study, was looking at Polish women. So, they eat about 30 pounds of sauerkraut a year, which is like about almost a pound a week, right? It's a lot of sauerkraut. And, What's amazing is when they move from Poland to America and they eat the American diet, their risk of breast cancer goes way up, whereas with the sauerkraut eating in Poland, they have very low rates of breast cancer.

Interesting.

And the same correlation study. Yes, but still important to pay attention. The same is true when you look across the board at longevity zones. When people leave those longevity zones, like in Japan and they come to America, they get the same rates of disease as Americans. So, it's really, it's not so much your genes as the environment. and so fermented foods play a big role in our keeping a microbiome healthy and regulating all sorts of things from cancer to heart disease to obesity, diabetes, to mood disorders. It's kind of cool. So I think if you can tolerate them, it's fine. If you have, for example, histamine problems or if you have a tiny yeast overgrowth or really bad dysbiosis, it can be a little bit challenging to eat those foods, but I would include those on a regular basis.

Which ones do you include on a regular basis when it comes to those fermented foods?

Oh, I like miso, I like sauerkraut, I like tempeh, and those are my favorites. Do you do any kefir or sheep's milk yogurt? I like sheep or goat yogurt, but I don't eat it that much.

And is it in the yogurt form? Because when you go to Whole Foods, for example, they'll have goat and sheep yogurt, and then they'll also separately in these larger bottles have go kefir. So there's yogurt and then there's kefir.

Do you choose one over the other? I like yogurt. Kefir is liquidy.

I mean, they're both fine. Okay. There's a brand that I've been eating a lot, no affiliation with them. It's called Redwood Hill Farm. And I do not consume dairy on a regular basis because I always have dairy and I break out. I break out in it just immediately. But I've been having this Redwood Hill.

Farm goat milk kefir. They have Whole Foods other places.

It's great. Get the one that's unsweetened.

And the goat milk is important because it's A2 casein, which is what's not causing all the inflammation, the A1 casein.

Is what's causing your pimples. Totally, and I don't break out, I feel good, I feel like my gut health is stronger than ever before. So just an example of, we'll be writing a newsletter on this whole topic. So typically, Mark, people are not making.

These products, although you could. My daughter makes them, I wouldn't have.

A whole thing of kimchi being made. Well, maybe we could all buy from her, but she's too busy being in medical school, so I don't think she'll have time for that. but typically people are not going to make them and they're going to get them from the store. Just a couple of odds and ends that you want to make sure, just like the kombucha, what do you want to make sure that people are looking out for when they're buying some of these things?

I mean, if they're buying fermented, I would stick with really traditionally made fermented foods, pickles, sauerkraut, miso, kimchi, things that have been around and been done for thousands of years. Tempeh, natto, all those are really wonderful to include in your diet and see what you like and what you enjoy. So Mark, another thing that I found.

Super fascinating about fermented foods that I have inside of my show notes here is that fermented foods are shown to reduce markers like interleukin-6 which is an inflammatory cytokine. So break that down. What are inflammatory cytokines and how is it and what mechanisms that you could guess that fermented foods would play in that would reduce the overall inflammation in the body?

Yeah, yeah. So First of all, cytokines we've heard about in the face of COVID and the cytokine storm, which kills people. Essentially, it's a flood of these inflammatory molecules. And cytokines are the messenger molecules of your immune system. And they have all kinds of names. One of them, class of them, are called interleukins. And there's many, many different kinds. Some are anti-inflammatory, some are inflammatory. Interleukin-6 particularly is a very common one. It's very high in belly fat and visceral fat, abdominal fat. It's highly correlated with heart disease, dementia, cancer. obesity, diabetes, and it's really driven off of a state of low-grade inflammation that comes from this visceral or belly fat on fire. The beautiful thing about our understanding about the relationship between the microbiome and our belly fat and our metabolism is that it's mediated through changes in the microbiome that drive inflammation. We talked about earlier the metabolic endotoxemia, the basic toxins in your gut that leak across and start to trigger immune responses. And the immune responses then generate a cascade of responses that increases certain cytokines like interleukin-6. So if you have a bad gut, if you have a leaky gut, if you're eating the wrong foods, you're gonna get higher interleukin-6, which is gonna create more insulin resistance, create more weight gain, create more belly fat and a vicious cycle. So the beautiful thing about fermented foods is that they can help reduce this process by normalizing gut function, by optimizing the gut in different ways through optimizing healthy bacteria, reducing the bad bugs, which then reduces the leakiness of the gut, which then further limits the inflammatory Cascade that results as a result of a leaky gut. So it's really, you know, kind of a beautiful story about how your microbiome plays a role in your immune system, plays a role in your weight, and, and how that all connects to eating.

The right foods and not eating the wrong Foods. If somebody's struggling with things like yeast overgrowth or histamine intolerance, are those two examples and are there any others of where fermented foods, because we read the articles or we read the headlines on the show and we say like, okay, this food is good for everybody. But if somebody's reacting to fermented foods, one, what could that possibly be an indication of? And number two, is there anything they should be thinking about doing? Yeah, so certainly fermented foods and their.

Stomachs just go crazy and blow up and they feel horrible. and that's because there's something going wrong in there. Something's rotten in Denmark, as Shakespeare used to say. So we have often bad bugs growing in there, used to overgrowth. We have something called C-FO or small intestinal fungal overgrowth, or CBO, small intestinal bacterial overgrowth. And that means that these bugs have migrated into small intestine. You started putting foods in there, and it starts battling. You start a war with the good bugs and the bad bugs, and you get all this. dangerous things that start to happen, which is more bloating, more gas production, more discomfort, more GI symptoms. So while fermented foods are good, they're good in the right person. Because if your gut's not sorted, and I call it the weeding, seeding and feeding program, if you haven't done the weeding and you got a lot of bad bugs in there, you start eating fermented foods, you're gonna be a problem. So you have yeast overgrowth, if you have small intestinal bacterial overgrowth, if you have histamine intolerance, you should be very careful. So if you don't react well to fermented foods, it doesn't mean fermented foods are bad for you. It means there's something wrong with your gut.

Find it and fix it. And can you still take a probiotic for instance and get the benefits? Because it's not exactly like there's a clear test to say like you have to go and do the weeding first. Unless sometimes you're working with a functional medicine doctor, they can help you interpret it. Sure. So in that instance, can you still take, right? If you wanna get some of the benefits, can you take things like probiotics and that could be one way if you're reacting to fermented foods to still get the benefits of the bacteria that.

You'D be introducing in your system? Yes, I mean, you have to be careful. If you have a tremendous amount of bacterial overgrowth and you take probiotics, you can get worse, just like with fermented foods. But the thing is beautiful, you can start slowly and then build up and it sort of kind of win the war over time. I'd be like to do this to weeding first, but you can actually start to seed and see how that works in a way that actually is a low dose initially and then you start to build up on the dose and people can generally tolerate it.

But it's often important to treat the underlying issues first. So, Mark, whether we're introducing fermented foods or not, and I hope that a lot of people are, right? Because it's a smaller part of the population that's gonna have reactions to fermented foods and needs to go on a little bit more of aggressive protocol, maybe with the practitioner. But whether we're about to introduce more fermented foods or start to have them on a more frequent basis or we're getting ready to include like a probiotic, a high quality probiotic into our diet, there are things that we can do to get our body and our gut.

Especially in the best shape to benefit from those things. So, what are some of those lifestyle recommendations? Well, you think about when you, when you plant the soil, to plant to put a seed in the soil, you want to prepare the soil unless you're using tons of fertilizer and pesticides and chemicals that you don't want to do. So how do you prepare the soil to plant a seed? So you have to do the same thing for your gut. Just as you're going to start your garden, you get rid of all the weeds and you dig it up and you make the soil nice. You have to do the same with your gut. And that can be done through herbs or some medications. If you have bacterial overgrowth, fungal overgrowth, parasites, that's what we call the weeding phase. The other part of the weeding phase is weeding out foods that cause problems. Because if you're taking probiotics, but you're still eating a ton of junk food and sugar and drinking sodas and having lots of gluten and your gut's a mess, it's not gonna work as well. So the key is to do a gut healthy diet, which is essentially the Pegan diet or the 10-day detox diet, things I've written a lot about. Then actually you can start to add these foods in because your diet's gonna start to change the garden very quickly. It's gonna start to get rid of the bad bugs, fertilize the good bugs, and then the probiotics tend to work better. So it's much better to actually take the probiotics in the context of a healthy diet than to try to make up for a healthy diet by eating probiotics.

Yeah, 'cause sometimes the approach with the modern world of supplementation, this always happens, is that there's this feeling that, oh, this is just gonna fix everything and I can just go and continue to live the lifestyle that I was living previously. But your food is always so much more of an impact than anything else that's out there. So cleaning it up over a period.

Of time is so important.

So important.

Is so key. So Mark, when it comes to shopping for probiotics, what are some of the things that people can be looking for when choosing the right probiotic?

I mean, it's difficult because it's kind of the Wild West out there and the regulations are really young on not matching the need. And so the bottle might say 50 billion units, but there might be five or it might say there's these strains of bacteria, but they might have put them in the manufacturing, but by the time they get on the shelf, they're not there. Or, you know, the cold chain might be broken, so the probiotics that are kept cold aren't cold and they degrade over time. So you got to really be careful and then you ought to know which probiotics. So, there's a bit of a science to it. With that said, there are some really good companies out there that are pretty reliable that test their products aggressively. We mentioned a bunch in the beginning. Encapsulations, Metagenics, there's others that are quite good, ZyMag, there's a lot of good products that we use in the medical space. So, I tend to focus on those. And, I think that when people are choosing, they should really be looking at where is it coming from, who's the manufacturer, what's the process, what's their quality control measures, do they test, and how do they maintain shelf stability, if it's a shelf stable product, if it's frozen, what was the cold chain like? So you got to kind of do a little bit of due diligence. And I think then you can kind of come up with, you know, probiotics that are for different things. Like I said, it's not like there's, it's not like just one size fits all. So different probiotics have different benefits for different people at different times, just like different drugs. So it's, it's going to be that personalized. So there are some general probiotics you take, like lactobacillus, symbiotic bacterium and others. but there's a lot of strains and things that are now coming out that are a more research-based strain. So it depends on what you're dealing with. If you're dealing with immune issues or hormonal issues or brain issues, I mean, there's probiotics for depression now, for blood sugar, for all kinds of stuff. I just, literally, I'm, I'm going to be doing an Instagram live with a famous actress who had diabetes and started taking a particular probiotic that helped balance her blood sugar. And I've seen this in other patients.

When they get the gut healthy, their blood sugar gets better. So there's really very much a future.

Of customized and personalized probiotics?

No, absolutely. There's a ton of great companies that are doing stuff in the space. And I think through education and digging in a little bit and asking the companies how they approach it, that's a big part of the process. Talk a little bit more about Lactose.

For, which is the probiotic that you put in your formula.

Yeah.

I mean, the reason we picked this is because of the level of data on this. This is a, a probiotic that's been well researched in randomized clinical trials, looking at its efficacy across a broad range of health issues, digestive symptoms, mood issues and more. And it's, it's quite when you look at it, it's a spore-based probiotic, which is quite different. It's shelf stable, so you don't have to worry about keeping it in the fridge. And, the data actually is quite amazing because it shows that it has dramatic reductions in GI symptoms. So, for example, the lactobacillus spore cuts down on irritable bowel symptoms by 42%, bloating by 47%, vomiting by, you know, vomiting by 47% diarrhea by 43%, overall GI pain by 68%. But, it also deals with other physiologic problems like depression and mood issues, like reduction in depression by 57% and improvement in quality of life scores by 47%. These are quite amazing data, sleep improvements by 58%. So we've got data showing that these kinds of probiotics work. And then I tend to rely more on the ones that are research-based that are used in the clinical studies that I can rely on and I know the manufacturer. So that's why we tend to pick these probiotic for our formula as opposed to just some random product.

A couple last things on the topics of probiotics. Almost everybody in the world has taken an antibiotic at some point in time and people are always curious about that. On one extreme, there's this deep, deep, deep fear that, oh my gosh, I've heard so much about the gut microbiome from functional medicine doctors and experts like yourself and I'm just worried to take an antibiotic ever. And on the other side, it's like the data is way overblown. We don't, you know, we're fine, antibiotics, the body's resilient.

Tell us where you lie on that spectrum of things. I mean, look, antibiotics have been a huge benefit to humankind for sure. And without that, many of us would be dead right now, no question about it. But there's a downside, which is they wipe out a lot of Keystone species in our gut, in our microbiome. That leads me to kind of wonder about how we can actually kind of reset our system after antibiotics. So, I'm very aggressive with my patients if they've taken antibiotics to rebuild their gut after. I always put them on the Saccharomyces while they're on antibiotics because that helps prevent antibiotic-associated diarrhea and also changes. And then afterwards, I make sure they take a good three, four months of a good multi-complex probiotic after. And it's really important because if you don't, you're just kind of going back to, you know, having these altered microbiomes that never reset. you want to reset them and you also want to use diet to reset them too. That's really important. So the diet is the best way to create a sustained change in the population of your microbiome and the probiotics really help regulate your immune system and.

Leaky gut all along the way. All right, Mark, well we talked about a bunch of companies that you love and use and trust on a regular basis. We'll have a link to those. We're all about lifting everybody up and highlighting and putting the spotlight on companies that you love and that you use in your clinic and they use at the Cleveland Clinic as well too in some cases. So we'll have a lot of links to those in the show notes as well as some studies that we mentioned. We'll put those in the show notes as well. And with that, I think we can.

Go ahead and conclude today's episode. Well, thanks, Drew. It's been fun class. I think we really always have more to learn about the microbiome, about probiotics, about how to fix the gut. And the exciting part about this era is we're learning more every day, and.

I'm learning more every day. And I've been doing this for 30 years, so it's pretty exciting. 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 and 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. So one is the microbiome is an ecosystem. So we know a lot about ecosystems, you know, about diversity, we know about relative abundances, richness. So 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 microbes that cause these patients. 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 the film expedition for six weeks and lived with them. So I never, wow. 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 on the world. and have lived with them.

So these hunter gathers 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's 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. you know, in the layer insulating our immune system.

Like acemannia.

Yeah, like acemannia. That's kind of a converse and a controversial species because it's been involved both in or implicated both in good and bad aspects of the, you know, 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 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, and the other sort of phenomena that is so fascinating to me about the microbiome and, 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... 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 one interesting aspect that we have understood 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 effects on, for example, estrogen levels in our blood are to a large degree influenced by these microbes, particularly after menopause. And bile acids have become a major factor. And as you said, I mean, there are good ones and bad ones. Nothing is simple in this world. So in general, people with 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. And then there's a third group of molecules that are actually part of the microbes themselves in their cell wall. So 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 the membrane molecules directly talk to the immune system. And 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 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 L-kannuramine, 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, the 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-hydroxyindole 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. So, other amino acids, and we probably have a lot more of these other metabolites that are being generated. 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, 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 what's 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, why, and how do we end up where we are today? One is the diet, but 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, you know, from extinction many times. But these systems are not designed as adapted for chronic ongoing stress, which we experience obviously since 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, you know, 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 bi-directional system, brain talking to the gut, talking back to the brain. And the signals that the brain sends via the sympathetic nervous system can talk directly to the microbes and make them more aggressive, changes their 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. Now imagine in our world, an unhealthy diet that does exactly the same thing together with the brain impulses. It's the worst thing that we can do to our gut health. And since gut health doesn't spin, 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. 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 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, 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 me 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, you know, they're being generated by the microbes and that 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, you know, 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. And 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. Of. Of neurotic housewives, you know, 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, I think I, I give, I give you and 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 scientists, I still.

Have some- I don't agree with everything either.

If I can't, there's certain areas. 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 a university, you would actually learn a lot. So for example, the leaky gut I learned from my patients, learned it from physicians like yourself long before this became an accepted term. So I think that the system will gradually change. I mean, there's now like at UCLA or other places, like GI wellness programs that deal with, you know, relaxation, mindfulness-based stress reduction, diet, sleep. They really look at the whole, at the whole human being rather than just the organ or the, you know, 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 we, I think we need to find, we need to get examples of, and unfortunately this will take well controlled, randomized controlled studies to convince, you know, much of the medical world that this is actually happening. I, I can just, I mean, I can already hear it now. People say, oh, there was all this excitement, like when you wrote your book about the, 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 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, for, for example, as a gastroenterologist, so we now know that, you know, people get colon cancer earlier than 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 or these 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. What a concept. Yeah. Well, you think about it.

You put pounds of. But you make more money doing colon cancer. Right?

Yeah.

That's true.

You make more money. But you put pounds of food in.

Your gut every day.

How do gastrinologists 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 avoid these foods if you have reflux, but it's very limited and superficial. 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 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 your sleep. stress reduction. I, 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, you know, rapidly becoming available, anybody can do from their home in 10 sessions. So I recommend all these things plus the diet. and, yeah, from a dietary standpoint, I mean, obviously, this is a Minefield, you know, as, as, as you know better than anybody else. Sure. I've come to this conclusion and pushes in, in, in, in my book that if, if you eat the things that are best for the, 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, it's a maintenance. You can rely on your diet part. Yeah. Or but I always look at this, you know, these multiple channels that we have to access the brain gut microbiome access. 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, you know, carbs or what percentage. I, I think it becomes very simple. you know, 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, you 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, of us, too, and and the environment, you know, is, as we know from, you know, a largely plant-based diet being beneficial for, for environmental reasons.

So, so, you know, I want to.

Just sort of summarize a little bit here, because what you're saying essentially is that we can treat a whole host of chronic diseases that are in origin inflammatory, including all the brain diseases, including depression, which is inflammatory, as autism and ADD and Alzheimer's, these are all brain inflammation diseases.

So what you're saying is we can.

Alter the course of these conditions by changing our microbiome. And then a lot of it has to do with our diet, with exercise, stress reduction, sleep, and maybe some other things that we haven't really talked about, such as whether there's probiotics or prebiotics or things that can help fix the gut. So talk about how we sort of need to sort of eat differently, specifically for the microbiome. You mentioned plant, I like to call it plant rich diet. But how do we design a way of eating that facilitates a similar kind of microbiome, for example, as the hunter gathers? We all need to be paleo, as we call it, or what should we be doing?

Yeah, I would say, you know, I mean, I stay away from these categories like paleo or keto or, because I think it's that they're so contaminated by political and personal, strong personal feelings that, you know, I actually went to get a blurb from a book from a prominent person in this diet field. And he didn't like that in my book there was one sentence about eating fish and chicken. And he said he cannot write a blurb for a book if it has that sentence if I would change it. And I said, I'm not going to change it. But this is the kind of world I think that we have gotten into that people are so fanatic about certain types of diets. So I would say, I mean, the things you want to do is you want to create as many different microbes or nurture as many different microbes as possible. And since they're all specialized in different types of fibers and different types of polyphenols, the greater variety of the food, the more we force the system to diversify. and that's really the whole goal in it. And then continuing this, this doesn't help just to do it once. You have to really change your lifestyle. This has to become a permanent, you know, way of eating. Then you nurture the richness and the abundance of this expanded ecosystem. We know we can't go back to the ones of the hunter-gatherers or some people, the hot spot in East Africa, because some of them, sadly, some of these microbes have actually disappeared or extinct, just like, you know, we can't bring back, you know, the animals that have gone extinct, even though, yeah, genetic engineering CRISPR may make that possible again. But, so we can't, but we can bring back about, I think we can reach about 80% of that these kind of systems if we stick to a diet like this. And I would say in addition to the variety, different types of fiber, plants, fruits and vegetables, it's also external microbes. So you mentioned probiotics. I personally would recommend if you have access to natural. And if you like the taste of natural probiotics and fermented vegetable or dairy products, go with that. If you don't have access, you know, take, take a supplement, which is often a challenge because there's not enough controlled trials that would actually show you this one is better than this one, you know, and So the way people have dealt with it, you mix a whole bunch of them together in very high concentrations. We don't know if that mix is actually better than if you had a couple, you know, that make the big difference. But if you look at countries like Korea, you know, that consume a vast amount of fermented products from infancy on, I would love to do a study on these chronic diseases. if there's actually an impact on that. Well, this study has not happened so far, to my knowledge. But this is what I would recommend, you know.

Yeah.

And there's, there's also one thing that, you know, I think it's really important to mention. It's not just what we eat, but also when we eat it. So there's always three things that I think what we eat, when we eat it. and where does it come from? Those are the three main criteria I think you should make. So when we eat, as you know, and as the audience knows, there's a lot of these intermittent fasting strategies, beautiful results in animal models, me being the big skeptic of animal models from my own personal negative experience. You know, the human studies are not as convincing. because they're more difficult to do. They have started now randomized control trials. Of all these strategies, I personally like the time restricted eating because I think it's the most realistic. There's studies now on the microbiome that actually that positively affects the microbiomes that, you know, mice that are on time restricted eating can actually eat what's called a cafeteria diet, a very unhealthy diet. without developing metabolic syndrome. So just, but it works better when.

You eat healthy though. I've seen those things.

Yeah, it definitely works better. Yeah. So, and this goes sort of into this whole concept of the keto diet. So you're in a ketogenic state for 18, for 16 hours. If your first meal of the day is at noon time and it's without any carbs and sugar, you can extend this ketogenic period even longer. And so you get multiple benefits. And so we have started this during the pandemic in our family and actually works really well. It's feasible. It's not, I'm not sure if I could fast two days a week on a regular basis, even if I wanted to do it. But the time restricted eating, I think, is something. So combining that kind of microbiome targeted diet, largely plant-based with the compression of the time when you eat it, I think right now, in my opinion, is sort of the optimal way of influencing your metabolic health.

If you love that last video, you.

Should check out the next one for.

Sure on getting the root cause of all disease.

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.