FIX YOUR DIET & Eat These Foods To Help HEAL YOUR BODY ! | Mark Hyman

Stress plays a big role in diverticulitis.

You know, this is a common problem that's preventable mostly from lack of fiber and a healthy gut.

And our diets have just gotten worse.

We are living in a world where we torture our guts. And the gut is so important to overall health and for many reasons. Obviously the microbiome we've been talking about a lot. But, you know, one of the things that I remember from medical school, you probably remember this was a guy named Dennis Burkitt who was a physician from England who went to Africa. And he studied. He studied the difference between the populations that were hunter gatherers and the same genetic crew that had moved to the city and were living in urban African cities. And he found that the average stool weight for the hunter gatherers was two pounds a day because they ate so much fiber. And the average stool weight for the city dweller was 4 ounces. So 4 ounces versus 32 ounces. Okay, yeah. And he found that it correlated with all these chronic western ailments, things like cancer and heart disease and diabetes. But he also noted that the hunter gatherers had no diverticulitis or diverticulosis, which was fascinating. So this is an entirely western disease and is a really reflection of the lack of our quality diet, the lack of fiber. I mean, we've had about 8% of our diet now is fiber. It used to be 100, sorry, 8 grams of fiber a day for Lucky, maybe 15 if we are on the high end of the American population. And in hunter gatherer times, it used to be 100 or 150 grams a day, which seems like a lot, but it's actually what our guts and bugs like. And that's led to this problem of diverticula. So, George, take us through. What are diverticula? How do they form and why are they a problem and who gets well?

Yeah, before I get to that, I just want to say that the Dennis Burkett story is a great one. And, and he was a phenomenal doctor. And nothing's changed because they did recent research that compared Ugandan.

Population to the United Kingdom. They looked at 1200 people, Ugandan versus 1200 in the UK and they looked at gastric transit time and stool weight. And the gastric transit time for Ugandan is 34 hours. For somebody in the UK, a Western population, it was 80 hours. Okay, 80 hours.

Oh my God.

Pass through your gut. And the stool weight was again, that phenomenal numbers that you just talked about, 110 grams of stool weight for the average UK population and for the Ugandan it was 400 grams, four times heavier.

Wow.

So, so nothing's changed since Dr. Burkitt made his first observations. It's still insane. And our diets have just got gotten worse. So, so yeah, to just start this conversation.

Just a couple definitions like what are divert, what is, you know, where does this, how does this all start? So diverticula are little pouchings in your colon. So your colon is this long tube and it's, it's wrapped with mucosa on the inside and on the outside layers it's multiple layers of muscle and then another final layer. And so it's like, you know, you've heard of hernias. Hernias are getting out pouching of your, your internal organs through the fat and the muscle layers until it's sticking out in your abdomen. Most people are aware of those. Well, the same thing happens inside the colon. You have the inner lining starts to push through and form a sac and it's just a, and that sac is a diverticula. Now you're actually born with diverticula. So there you're going to have maybe one or two diverticula when you're born and that's. But as you get older you begin to have more. And so research has said that at least 35% of people that are under age 50 have multiple diverticula and have diverticulosis. And then above the age of 60 you're looking at closer to 70 to 80% of people have diverticulosis. And then 5% of people, adults will go on to have diverticulitis. What's diverticulitis? That's when those diverticula become infected and so you get bacteria that gets in there and you have now an infection and that can spread the multiple diverticula. And it usually happens on the left side of your abdomen where your colon, your large intestine is descending and then it goes to the sigmoid colon and then the rectum and that's where the stool comes out. It's that, that lower third of the descending colon and sigmoid that are typically affected. And if you've ever had it, and unfortunately I've had it, and it is extraordinarily painful. They call it the appendicitis on the left side. So left sided appendicitis, it's that painful and you can get nauseous and you can get fevers and you can get chills and you lose your appetite and get constipated and it's just really really?

Oh, it sounds like fun.

Yeah, it's not. And so.

Yeah, I'm not a very fun patient. So I don't think anybody in my house is having fun when I had it, and I certainly wasn't. So.

It'S an issue now. I'm not the only person that gets it. About 200,000 people per year get it and many of them end up in the hospital, although now we do a lot more treatment outpatient. So what are some of the risk factors? So if you're over 40 and you're male and you're heavy, overweight or obese, if you eat a low fiber diet, we've already talked about that. If you eat a diet that's high in inflammatory fats, you're going to have a problem. If you don't exercise and if you take non steroidal anti inflammatory drugs like aspirin, ibuprofen, which is Motrin or Advil and, or you use steroids or opioids or you smoke. Those are some of the major risk factors for going on developing diverticulitis.

Amazing. And so, George, we really figured out that this is a common problem that's preventable mostly from lack of fiber and a healthy gut. The traditional treatments are basically surgery and antibiotics. Then it just keeps coming back. So from a conventional perspective, what can we do to prevent it and what do we do to treat it differently? So take us through what that would look like.

Well, I think you mean from a functional medicine perspective, what it would mean.

Yeah, from a functional medicine perspective.

Yeah, because conventional medicine doesn't prevent it. And that's the big difference. You know, conventional medicine does what it does best. It treats disease and it does that really well. If it's acute disease. And so you have these diverticula floating around, you know, you're going to have tons of them by the time somebody turns 60. And you know that at least 5% of those people are going to end up with diverticulitis. But we'll just let it happen and we'll treat with antibiotics. And if there's a complication like an abscess or an obstruction or a fistula forms, you know, you have a tract that goes from your intestine to your bladder or intestine to your uterus, because we let that infection fester and get out of hand, then you're going to need surgery. And so that's how conventional medicine deals with it. Functional medicine. Now we don't think of it as just a fiber issue. There are more things going on. We Start to think about the gut microbiome and imbalance in the gut microbiome and how that can lead to leaky gut and inflammation.

That whole process can be avoided. We think about gastric motility. Yes, fiber can improve gastric motility, but, you know, there are other things that play a role in gastric motility. And some people, once they hit that point where they have irritable bowel syndrome with constipation, their gastric motility is oftentimes beyond improvement with fiber. And we have to be addressing that. And so we look at motility, we look at the gut microbiome balance, we look at the gut permeability, we look at.

The possibility for inflammation. So we look for, you know, stealth infections. And we do this before people develop diverticulitis. We help them arrange their diet and their lifestyle. Because stress plays a big role in diverticulitis. I know the time I, the time I had it, I was under enormous amount of stress and of course, my diet wasn't as good as it should have been at the same time. But stress plays a big role because we know that cortisol produced by the adrenal glands impact the makeup of the gut microbiome. You can have less favorable bacteria that can cause inflammation, that can push out the good bacteria that can protect us. And so when that happens, we can also. Cortisol can also trigger leaky gut. And when that begins to happen, when that process happens, now you're starting that cascade towards inflammation that will lead to.

The infection that results in diverticulitis. So that's how we approach it. We look at it much deeply, much more deeper, and we're attempting to prevent and to maximize and optimize gut function that prevent disease. And maximize and optimize gut function.

That's really amazing. And so what are the kinds of things you would do diagnostic wise to look at things differently and can you maybe share, you know, some case story of a patient's?

Yeah, so. So, you know, once the diverticulitis happens, I can tell you I've seen it enough that in an outpatient setting, just a clinical presentation is usually enough, because most people have had, you know, by the time they have their diverticulitis, I'd say three quarters of my patients have at least had a colonoscopy and they know they have diverticula. So I get the call. Hey, my gut's killing me. What side left? How old are you? You know, I know, I know their age. I'm usually looking at your chart and I You know, I can pretty much know that, yeah. And did you have a colonoscopy? Yeah, I had one two years ago. Did you have diverticuli? Yeah, I remember he told me that it's a left sided pain. It's really painful. They're really struggling. I mean, it can be as simple as just using your observer, your powers of observation, your experience and the art of medicine that you've developed, your years as a doctor to make that diagnosis. It can be done as simple as that. If I need further confirmation, I can get a blood count to look for elevated white blood cells. If I think there might be the possibility of something else, maybe a bladder infection, I might get a ua, urinalysis. Ultimately, if I need to confirm what's going on, you get a CAT scan. That's a definitive way to diagnose it. And then on a CAT scan, you'll see swelling and inflammation of that lower third of the colon and maybe sigmoid. And that's how the diagnosis of diverticulitis is, you know, finally made. And then the treatment is typically going to be, you know, antibiotics. There are a host of different pharmaceutical agents that would be used and they can be done orally and you can stay at home or if you're really that sick, you'll get IV antibiotics in the hospital. And then hopefully you don't have any of the complications like development of an abscess or obstruction or possibly even a bursting of your abscess. So now you have all this pus and bacteria flooding into your abdominal cavity. That's, that's bad. And if any of those complications happen, you might be getting surgery done. And surgery can be either laparoscopic, where they enter in with tubes and are able to take out a piece of your colon, or it might be open surgery to clear out the, the abscess or clear out your abdomen if the abscess is burst. So those are, that's the sort of the horizon, the playing field of treating diverticulitis.

And that's the acute diverticulitis. Now if you have a mild case like I had my really, you know, bad episode, but I had, you know, after that I had another episode where I just knew it was coming on. I could just feel it starting to happen. And so if you're getting there, you don't have to wait. There are things that you can start to do. So I did and I ended up getting better within like five days. Didn't move on to becoming an all out problem. And what I did was, is I used Bone broth. You know, bone broth has enormous amount of nutrients as, you know, antibacterial capabilities. So, you know, I stopped eating a solid diet and I made a big batch of bone broth. You get water, you get a antibiotic, you know, hormone free chicken, you dump it in, you chop up some root vegetables, you put in some great herbs, you know, thyme, rosemary, you put in garlic and onion, you put in carrots and celery. And you just let that boil and simmer it for 24 hours, adding water. And then you have, you know.

A lot of bone broth. And so then I would just drink it like it was coffee or tea throughout the day. And I also did drink clove tea. Really? Clove tea, really high in polyphenols. It's one, it's one of the botanicals, peppermint tea. Peppermint and clove have some of the highest levels of polyphenols. Why are polyphenols important? They are really good at restoring your gut microbiome. Phenols are really important to the health of your bacteria. And so I was doing clove tea, my bone broth, and I was getting, I was juicing, I was just using some fresh juice, taking the, the pulp out. And I did that for, for about 48 hours, about 72 hours. You know, I really felt like the pain was starting to diminish.

And the clothes, put clothes in water and boil them up.

Yep, exactly what I did. I have a little tea basket and I just crush up the clothes, put in a tea basket, put it in hot water and there you go. It's really good.

Amazing.

Yeah. And so, and then you can slowly begin to add in, you know, some, some vegetables, raw vegetables, some quinoa and refined grains, fermented black rice, you know, fermented grains like barley, spelt. So I added those things in slowly. And then by day four, I was feeling really good. I started adding in, you know, more, more fiber. Now, two things I want to mention. In the conventional world, you hear, hey, if you have diverticulite, don't eat seeds, right? Well, that a lot of research done and recently.

Nuts and seeds are not the cause of diverticuli, in fact, because.

What is with that advice? Because we're all told you're a diverticuli. Oh, I can't eat fruit, I can't eat raspberries, I can't eat seeds. Is that really true?

No, it's not true. The research shows and it's already pretty much now if you read anything on diver on diverticulitis you know, you'll be told you can eat seeds. I think it was more of a mechanical issue that these things get stuck, that even the smallest seeds from.

Berries can accumulate inside the diverticuli become, you know, then block bacteria in there and then you get the, you get the diverticulitis that's been debunked. You can eat seeds. In fact, because of the high levels in nuts and seeds of.

Linoleic alpha linoleic acid that becomes omega 3s, they actually have an anti inflammatory effect and it's shown to have a benefit for helping you avoid diverticulitis. And also as you're getting better from it, it can help the healing process. So nuts and seeds and the other one is fiber. So fiber is, is, you know, has been said don't eat fiber because during your acute diverticulitis because it's going to build bulk and it could pot stretch the colon. You might get a rupture and so.

Or the seeds will get caught in the, in the diverticuli and cause problems.

You got seeds and diverticuli and then you're, you know, during your episode you should avoid all fiber. Well, you know, when I started feeling a little bit better, I didn't want to have fiber because I wanted to start moving stool through. I was constipated and I knew that to get better I needed to get those toxins out of my, my bowels. So then I started adding in fiber and I added in both, you know, the soluble kind of fiber like the oat bran and nuts and seeds and beans and lentils because that absorbs lots of water. It gets, it gets like, I'm sorry, it gets gel like in its quality. It actually slows things down. But it allows all the nutrients from those, those, those fiber foods to be absorbed by the gut because those, those nutrients are very healing. So you get a super high saturation of good.

Compounds and nutrients from those types of soluble fibers. And then insoluble fiber, you know, I add in because that's going to absorb water and move bulk through and allow me to detox and clean out. So about that third or fourth day when you're feeling better, it's only a mild episode. You can start adding in insoluble fiber and, and.

Soluble fiber because they do two different things. And the insoluble fiber is going to be more of like your, your grains, your cruciferous vegetables. You can even find it in, you know, avocados. In some fruits you'll find certain levels of the insoluble fiber that will bulk up your stool, make it nice and soft and pass through. Now that's, and that's what you should be eating all the time because you want those nice full bowel movements. That's why fiber is so important. So that's a way that, you know, you can treat a mild early diverticulitis if you want to really try and keep it from getting worse to the point that you're going to end up in the doctor's office, the emergency room, and they're going to start doing all types of bad things to you.

Yeah.

And.

There are some targeted supplements that you can use that can help the gut heal. Glutamine.

Some of the other things I use marshmallow root.

Those are some of the.

Targeted supplements that you can use that are healthy for the gut. I'm just having a little bit of a mind blank on some of the other ones. There's slippery elm, marshmallow root, glutamine.

So you can apply those to as well when you're starting out with your mild early diverticulitis.

That's great. So basically we're getting people on a gut health program. Right. And we're looking at things that help. So talk us through that patient you had, the 52 year old with our son.

This is a really interesting patient, what.

You found and how you treated her and helped her.

So this is a 50 year old female who had arthritis in her right hip that was planning on.

A hip replacement. She had long standing constipation. She had recurrent diverticulitis. I think it was over like a three, maybe four year period. She had at least one episode a year. It may have been, you know, less than four years, maybe three. But so that occurred prior to seeing me. And she was coming to me primarily because of those recurrent reticulate episodes. Episodes and the fact that she'd been constipated for most of her life. So interesting case. The things that were, you know, running through my mind were like, why would this woman have so many episodes of diverticulitis? And so I asked her, you know, of course, about her hip and the pain had really gotten a lot worse. She, as I said, was planning to have hip replacement, but she was eating Advil all day.

Oh, wow.

And so Advil is one of those triggers for inflammation in the colonic tissue. And, and she had diverticula. And so now with the constant use of the NSAIDs that had increased over the last three, four or five years, she was triggering diverticulitis and on top of that, she'd been constipated most of her life. So. So the tests that I ran, I ran a stool test. So the stool test is again, always looking at the gut microbiome, giving us the balance between good and bad bacteria. It's giving us information about how well you're digesting. Do you have everything you need to digest? Well, it's letting us know if you have any stealth infections that you've picked up along the way, parasites, viruses, protozoas, that may be impacting your health.

And that test also has an inflammatory marker called calprotectin. So calprotectin can tell us if you have this chronic, ongoing inflammation, which is not uncommon in the diets we have today. It's not uncommon to have this stealth inflammation that you just don't know about. So I checked her calprotectin because she had irritable bowel constipation. 50 to 60% of those patients have small intestinal bacterial overgrowth. And that overgrowth can lead to constipation, can lead to slower gut motility.

Yeah.

And then that becomes that setup. As you get older, one of the pieces to the, to the puzzle that might give you diverticulitis. So I tested her for that and I did some gluten and food sensitivity testing. So what we found on her was that her calprotectin was indeed elevated. So she had market inflammation. She did have sibo, so. And it was methane producing bacteria. And methane producing bacteria have a significant impact on gut motility, particularly on something called migrating motor complex. So I want to mention that because I think it's really fascinating and it's part of what we try and do with our diet. But when you eat, you know, you get that rumbling in your stomach, your intestines start to move. That's peristalsis. That's taking your food. It's being broken down, moving it through your system, having it broken down, getting it digested, and then finally it's going to leave your body. That's the peristalsis engaged when you eat. But when you stop eating, about 90 to 120 minutes later, there's a signal that happens that triggers something called the migrating motor complex. There's no food in your stomach or in your, you know, or traveling through your intestine. But your brain tells your intestines to start moving. And so you might notice that you get this, like, growling in your stomach, or you notice that your intestines are moving and you haven't eaten. That's the migrating motor complex. And it's, it's the street sweeping effect. It's doing that secondary cleanup in your gut of any food that hasn't been left. It's really important, particularly in the small intestine, because if food particles stay there, they become a nidus for bacterial overgrowth. And so, and that bacterial overgrowth leads to sibo. Sibo leads to either diarrhea or constipation. It leads to inflammation. It leads to nutritional deficiencies, malabsorption. It can, it can trigger your, your, it can actually have an upstream effect where it will cause less gastric acid in your stomach. It might impact the ability of your pancreas. You appropriately discharge pancreatic enzymes to break down fats and carbs. So it's a, it's a, you know, it's an important thing to understand. And why do I say that? Because you, it's. If you have problems with constipation and even diarrhea, you're probably having a migrating motor complex issue. You have to let them turn on and do their job. And that takes about four hours. So snacking between meals when you have yoga bow is not a good idea. You want to give yourself at least three to four hours between meals so that you can get this migrating motor complex to do that secondary peristaltic sweep up. So that's why I wanted to mention that so that any of our listeners might have that issue. That's a key fact because gut motility, when you're dealing with either ibs, constipation or diarrhea is a big deal. And a lot of people don't know about that migrating motor complex, the need for it to be triggered and do its work.

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So what did I do with this young woman? I basically found out that she had the sibo. I treated her sibo. I used botanical antibacterials. I gave her some gut motility activators. I used five htp. I used ginger and artichoke to get her motility to work. Told her to stop snacking between meals, and we were able to clear up her placebo.

For her inflammation. I, you know, just had to clean up her diet. I really, a lot of information was coming from her diet and her NSAIDs. So there are two things I did. One is I Started to give her really high doses of fish oil. And then I used to something called spm. Those are special pro resolvings that are, I call them super concentrated fish oil. It's derived from fish oil have a very potent anti inflammatory and an inflammatory modulating effect. So SPMs, high dose fish oil. I put her on 4 to 6 grams a day. I put her on some curcumin that was really high end curcumin that's readily absorbed and I had her using that instead of NSAIDs for her pain. I also added in some CBD oil and between those things she was able to stop using her Advil, reduce her inflammation as we treated her sibo.

And.

Those are the major things that turned her around.

That's great.

And so you know, that's great. She has, yeah. So she, and she's gone on. It's been almost two and a half years and she hasn't had her diverticulitis return.

So basically if you've, if you don't have it and you want to prevent it, it's really focusing on all the things you mentioned, your diet, stress motility and dealing with those things before they become a problem. And then if you have it, if you have diverticulosis, which you'll find often on a colonoscopy, you want to make sure you're really up in the fiber and the food program that you mentioned. Things like the, the increased fiber rich foods of nuts and seeds and you know, lots of fruits and veggies. And don't worry about all the seed thing, it's fine. And then if you get it, there's things you can do to actually deal with it acutely like bone broth and you know, eating, eating fruits and veggies and different grains and fibers and protein and so forth. So it's a very different perspective about how we address.

The problem of diverticulosis, which is really common. Like you said, it affects most people as they're older.

Yeah.

Hey YouTube, if you like this video, you're going to love the next one. Okay, so let's talk about this thing called irritable bowel syndrome. What did we learn about it in medical school?

Not much. I mean we, I think we, we basically learned that was one of those conditions where you sort of treat the patient and it's not serious, you're not going to die from it. And I can remember actually up at Dartmouth we had Dr. Almi and he was a, an expert in irritable bowel. And back then it was felt to be More of a sort of neurologic sort of like stress related thing.

Psycho emotional.

Psycho emotional. And actually, I'll tell you, this is interesting side story. He did a test where he took some medical students and was measuring the manometry of them. And while he was doing the sigmoidoscopy, he was measuring the tension in the colon. And then he, while doing the. You can only do this to medical students. This is back in the 50s. And he told them, he goes, I think I see cancer. All of a sudden there was a spasm of the colon. Oh yeah. And it was, and it was like he wanted to evoke, to see what it was that was going on with the irritable bowel. And they thought it was a lot of it was nervous related and which there is a stress component. And so back then, the concept of irritable bowel was that it was all sort of in your head. It's all sort of like.

We had a very fancy word for it in medical school. We called it supra tentorial, which is a doctor's way of saying it's all in your head.

It's all in your head.

The tentorium is that thing that kind of separates your top of your brain from the lower brain. It was a joke, but it was very pejorative. And we often thought that these patients were malingers. It was called functional bowel disease.

Yeah. A lot of terms.

There was no real cause for it. It was more psychological.

Yeah.

And maybe stress related. And these people are all emotional and upset. Turns out it's not so. Right. And we, and we call it syndrome.

Right, syndrome.

So when we say syndrome in medicine, what do we mean?

It's a constellation of various symptoms. And, you know, we, we now.

We don't know what the hell is going on.

We don't know what it's like. Yeah, it's like, it's like, you know, chronic fatigue syndrome. You know, it's like, you know, how many different things can cause chronic fatigue? It's like there's 23 flavors or how many flavors of Baskin Robin ice cream. The same thing with 31.

I used to scoop Baskin Robbins ice cream. That's one of my jobs.

Right, right. And then that'll probably cause irritable bowel, probably with all those artificial, artificial flavorings and sugar. So. Yeah, so. And you know, nowadays we sort of classify irritable bowel into irritable bowel with constipation, irritable bowel with diarrhea, and then mixed irritable bowel. That's how we're sort of, you know, putting an ICD10 code on it. And that's a way of conceptualizing it. But there are lots of different things that play a role. Without question, I think stress does play a role with irritable bowel. And I think that, you know, stress can manifest in the body in so many different ways. We've talked about this when we talked about autoimmune conditions, because oftentimes when we have a patient and some stressful event happens, it triggers a host of things and sort of like a ripple effect that goes on in the body. And without question, there is a stress component to some irritable bowel.

Well, yeah, I mean, you've got your second brain in your gut. There's more serotonin in your gut than in your brain. You've got this whole nervous system that connects the two that is extraordinary complex and feeds back both ways. So from the top down and bottom up. So irritable bowel can cause irritable brain and your brain causes a bowel. It goes back and forth.

Right. And you want to have a happy bowel, happy brain. That's, that's, you know, that's sounds like.

The key to a happy life.

Happy bowels, happy brain. Exactly, exactly.

And then.

Yeah, and there is that. It's an interesting thing that you talk about because you have that gut brain connection and it's like a two way highway and they're, they're basically communicating. The brain's talking to the gut and the gut's talking to the brain. And then you also have the enteric nervous system. And some people sort of forget about the enteric nervous system, and that's the intrinsic nervous system to the gut. So literally, if you, if you sever the spinal column and there is no connection to the gut and the brain, the gut still works. You can still, you know, poop fine. If you, if you sever the spinal column.

It's got a mind of its own.

What you're saying it's got a mind of its own. Exactly.

Right. But you know, Todd, I want to come back to what you said, which is really important. You said, you know, we categorize irritable bowel as with constipation or diarrhea or whatever. And there's a whole classification system that, that is driven off of symptoms.

Yeah.

And the difference between functional medicine and conventional medicine thinking about any disease is that it's not focused on the symptoms, it's focused on the causes. So just saying People have irritable bowel doesn't tell you anything about the cause. It tells you they feel uncomfortable, they're bloated, they have diarrhea, their bowels are weird, they're uncomfortable, cramping. Whatever the symptoms are is irrelevant when it comes to trying to figure out the cause. I mean, yeah, okay, you have irritable bowel, but that's when you start to think about the problem in traditional medicine. You name the disease, you stop thinking.

Right.

You know, our colleague Sid Baker always had this great term. He says traditional medicine is naming and blaming. You name the disease and then you blame the name for the problem. Oh, I know why your stomach hurts. You have irritable bowel syndrome. No, that's just the name of the problem. But, but he talks about thinking and linking, which is functional medicine, right?

Yeah.

You think about the problem and the cause once you get the diagnosis and you link everything together to see what the factors are. And there's no such thing as irritable bowel syndrome. There's IR bowel syndromes, like you said, there's 31 flavors, and each one is different and each one needs to be treated differently.

Exactly, exactly. Yeah, that's, that's, it's, it's, it's so, so, so true. And there is this, you know, this web like interaction in the body, and it's very important to understand the whole inter. Connectedness of it. It's very, very important.

So, so typically, go to the doctor and you have irritable bowel. What do, what do they tell you to do?

Well, you know, they, they, you know, they'll, they'll often tell you, you know, take some Metamucil and I'll see you later.

That's, that's, yeah, eat more fiber, drink more water.

Yeah, that's, that's essential.

Learn to live with it.

And, yeah, that's essentially what they're doing.

Deal with stress.

Yeah, deal with stress. Yeah. And they'll, they'll. The interesting thing this is I had a patient just the other day who I was seeing for GI symptoms. It wasn't specifically ir and the patient's GI doctor said, diet has nothing to do with your symptoms. I mean, it was, it was unbelievable that a GI doctor told her, diet makes no difference.

I, I couldn't believe it.

I, I just, I like.

Actually, actually I was on, I was on a consult with a patient yesterday, and she said, I went to my gastroenterologist and I, I wanted to show my stool test. He says, oh, gastroenterologists don't look at stool. I'm like, well then who does if you're a doctor? And I'm like, you know, that just doesn't make sense. You don't look at what goes in and you don't look at what comes out. How are you supposed to know what's going on in there? Right. And that's the difference in functional medicine.

Yeah, exactly. Yeah. It's sort of, it's a little bit mind blowing. And you know, you talk about like, you know, with going back to Sid Baker and sort of name it and claim it kind of a thing. Yeah. Name and blame it is that, you.

Know, and then tame it with a drug.

Right. And then I always, I always tell my patients, you know, I went from being a medical student to a student of medicine. I must, I like to always learn about things.

I love that.

And yeah, and it's a very important thing that you have to remain open minded. And I think you also have to remain curious because every patient's different. That's, you know, that's actually the joy of actually practicing functional medicine is. It's not boring by any means. It's a, it's. You're constantly growing and learning and helping patients with the latest diagnostics, the latest therapeutics to personalize their treatment. And that's the fun part. I mean, doing functional medicine is a wonderful profession as opposed to regular mainstream medicine where most doctors are burned out. You know, they really are, they're just, they're unhappy, they're. They're burned out, they're. They're doing rubber stamp medicine. You know, I'll see you. Here's your proton pump inhibitor. Next. Next patient. That's. Yeah, that's it. That's it.

So, you know, doctor sees you, you have irritable bowel, they give you Metamucil. What else can they do?

Sometimes. Well, sometimes they'll give prescription medications. I think one of the older ones that they used to do for IBS was Zel Norm, Remember that one?

Yeah.

They took it off the market because it was like really hurting people. I think people are getting Librium was.

The other one that was, that was like a Valium, basically taking value.

Is it Valium for the gut? Yeah, Valium. And they're actually in certain patients there were some benefits from that because it did sort of calm down the nervous system.

I think anybody, anybody taking value, you're going to feel.

I feel good.

A couple of shots of tequila, a little.

I feel good.

Right.

That's really not what we do with natural Medicine. You know, you were talking before about how you never know what the issue is when someone comes in. I was thinking about as much like Forrest Gump medicine. You know, Forrest Gump has a box of chocolates. Life is like a box of chocolates. You never know which one you're going to get. And I think in traditional medicine, you got irritable bowel. It's a thing. You treat it all the same. Functional medicine is not like that. We see some with irritable bowel, and then we go, wait a minute, what is the cause of their irritable bowel? And like you were saying before, it's very personalized.

Right.

So how do we start to think about identifying what their particular issues are? Because before we can even treat it, we have to understand the why. And that is what I always say. Functional medicine is the medicine of why, and regular medicine is the medicine of what, what disease and what drug.

And I think the big thing is time. Taking the time to talk to a patient and, you know, talk to a patient, actually, and listen to the patient. That's. Wow.

Listen to the patient. That's.

That's actually, you know, actually, sometimes the less I talk during an interview and, you know, evaluation of a patient, the better I do because, you know, oftentimes we want to jump in and ask this question. They'll say something, and we ask a question. You know, I think in the average doctor's office, a patient speaks for, like, 30 seconds. The doctor interrupts them.

Yeah, no, actually, there was a study published years ago in JAMA.

It was 18 seconds, 18, 24. DE Dr. Interrupt. Exactly. Because, you know, we're trained to, like, you know, probe the questions, and, you know, they have their own sort of path of thinking going down that. But I think the big thing is, you know, we spend a lot of time listening to the patients and getting a history and a story. And, you know, an important thing is interesting thing in terms of IBS patients is that babies who have colic and they've actually looked at what is it that causes colic in babies, you know? You know, yeah. The latest evidence is that babies that have colic have high levels of klebsiella. Klebsiella is a bacteria. And we know that klebsiella is actually associated with other inflammatory conditions and autoimmune conditions. So klebsiella, excess in the gut is actually associated with ankylosing spondylitis, which is inflammatory bowel disease, which manifest systemically with arthritic symptoms. So getting a History of colic is important. Listening to the history of, you know, were they vaginally birthed, were they breastfed, what type of diet did they have as a kid and when did they get food introduced? Yeah, yeah. And all those things can play a.

Role in terms of like early gluten.

Yeah, exactly.

Dairy.

Yeah, exactly.

Trigger leaky gut.

Exactly. And, and just there's really, you know, listening to the patient. Antibiotic use. Did they have a lot of ear infections? Do they have a lot of strep throat? Did they get a lot of antibiotics? What's going on in the family? Does anybody else in the family have any digestive issues? So just taking the time to get that history allows you to sort of play detective and try to figure out what are the things that are potentially playing a role in driving this and what might have triggered it. And then personalizing, you know, diagnostics and treatment and everything else, it's all about personalization.

I think it's very, very different. What you're, what you're saying this approach really is being a medical detective.

Absolutely.

And it is relevant whether you're breastfed or for example, or vaginally birthed, because that affects your gut flora and the development for your whole life. I mean, I recently read a study that showed bottle fed babies have a high levels of a, what we call a short chain fat, which is made by the good bacteria. This one is called propionic acid. Now this is not such a good one. And it's been shown to induce autism in animal studies and has been associated with autism. And ADD.

That is increased when you're bottle feeding. When you breastfeed, you get increase in butyrate, which is the beneficial short chain fat that actually heals the gut. Absolutely reduces inflammation, does all sorts of good things. So we think, oh, what's the difference? Bottle fed, breastfed. That's not to make people feel guilty if they have to bottle feed. You have to do it sometimes. But you can fix that by making sure they have the right prebiotics and the right probiotics. Because breast milk has undigestible fibers that are prebiotics and sugars that are prebiotics for the good bugs that aren't actually digested by humans. Absolute knows that.

Exactly. And the other interesting thing about breast milk, I mean, you know, if we could, if we could sort of bottle breast milk, it's very, very powerful stuff. There's, there's a thing in breastfeed called milk oligosaccharides. And these are very, very complex sugar moieties sugar, chemicals. And they're actually so complex that for a long time science didn't even study them because we, they were too complex. It was like this, you know, a Lego set that was this incredible building blocks and, and what they've done. Now there are a couple of companies, one company in specific out of Europe that's actually synthesized one of the oligosaccharides in milk. And there are actually hundreds of them. And these act like fertilizer for the good bacteria. So these, these, these things that are found in breast milk are very, very powerful things. Yeah, yeah.

So powerful. And so, so we dig down into the story and figure out when did it start and what's connected to it. Did you have foreign travel? Because pop, people often have post infectious irritable bowel syndrome. People can get it after antibiotics, people can get it after any kind of stress or trauma. And you know, people don't realize that it's connected to so many different things. So let's talk about, you know, what are the causes? And then we'll go into sort of a case of how we would deal with this. So what, what are the, what are the top causes that you found in functional medicine that are driving irritable bowel syndrome for people?

Well, a lot of irritable bowel also is probably misdiagnosed, I think, as sort of sibo. I think a large number of. And sibo is this diagnosis of, you know, small intestinal bacterial overgrowth.

So a bunch of people with a bowel have sibo or.

Exactly.

Bad bugs growing where they shouldn't be in the small intestine.

Exactly. Yeah. And I think that we're sort of finding that a lot of these people that were diagnosing with this catch all term is real. They're really having potentially small intestinal bacterial overgrowth. There are tests that you can do for that. We do the.

That's also known as a food baby. When you eat food and you get a big bloated tummy right after. And as a food baby, that's what sibo is.

Right. Because what's happening is we have bacteria on our skin, we have bacteria in our mouth, we have bacteria in our stomach. The small intestine, large intestine, Most of them sort of live in the colon, but there are times when the colonic bacteria start migrating upwards and they go higher up and it's sort of like invading a neighborhood.

Yeah.

You know, and they're mostly sterile up there. Most. It's. Yeah, it's, it's. Yeah, it's not, it's, it's. I think it's not, not necessarily that we always thought it was stable. Even the stomach has bacteria. Right. And, but it's just much less. And they're all different kinds of bacteria. So the, the lower bacteria are more fermenters. They, they ferment things.

Yeah.

And that's where we get, I think I've talked about that and I, I've seen this a couple of times. The auto brewery syndrome where patients, in fact, I just recently had a patient, fantastic case and he actually heard me on one of the podcasts where I was talking about auto brewery syndrome. So I did a consult with him and he ended up going and buying a breathalyzer.

Yeah.

And he confirmed that he has auto brewery syndrome because he was producing alcohol.

He was driving over the limit.

He was just short of the limit.

Saves you money on beer for sure.

It was actually quite interesting because he actually was doing a very, very strict low carb, no sugar diet. And even with a really, really good diet, he was pushing making alcohol. It was really quite interesting. So. Yeah. So, but anyway, so you know, talking about, you know, how do we, how do we diagnose this? So you can do stool testing. I like the, the, the GI map test where you can do quantitative PCR for bacteria, yeast, fungi.

That's looking for the, like the genetic material of the different bugs.

Yeah, it's like csi. Yeah, csi. It's, it's, I find it to be a very, very helpful tool. You can also do the hydrogen methane breath test. Although the thing about the hydrogen methane breath test is that I've had some patients who have significant, you know, irritable bowel sibo type symptoms. They're bloating and they're negative and they're negative. And I think based upon my reading of literature, is that they're probably producing hydrogen sulfide. Yeah. And I think that when you just sort of get a history of, in a past, very foul smelling gas, it smells like rotten eggs. That's usually the people that are producing hydrogen sulfide.

People don't realize it, but you know, cows just don't produce methane. Humans can produce methane.

Exactly.

If you have this and we measure that coming out in your breath, we measure hydrogen. We have to take this drink. And that's really a clue that there may be these bugs growing in there and they have to be treated directly and that can really help a lot of people.

Oh, huge, huge amounts. Yeah.

And it's often missed.

It's very much missed. And you also have to do the test properly because, you know, everybody produces small, small amounts of hydrogen and methane. It's just that you want it lower down in the colon. It really does. It doesn't become as much of a clinical issue. The other thing is to also think about in those types of patients is to make sure that they have sufficient amounts of stomach acid. Stomach acid is very, very important at helping with proper digestion. So you can actually do testing for gastrin levels. And I've been surprised at how many people have high gastrin levels. So when you're, you don't have enough stomach acid, your body produces more gastrin, which is the hormone to, you know, pump out more hydrochloric.

Fogging a dead horse.

Exactly. Absolutely. Yeah. And I would, I would venture to say that most people's issues are not high acid in the stomach. It's low acid. Yeah, it's low acid.

And we're taking more of these acid blockers, which by the way, also cause irritable bowel. So they help your heartburn, but they cause trouble bellow.

And now there are, there is a role for short term use of these, these acid blockers, like in the icu. The studies have been shown they've been very helpful to prevent stress induced ulcers and.

Hospital acquired pneumonia. But they're really to be used short term and when you start using them long term, they are very toxic. Yeah, they are very toxic. They produce increased intestinal permeability, they cause malabsorption of nutrients, vitamin B12, iron, other trace minerals, zinc. Yeah, yeah. And. And they cause bacterial overgrowth and they.

Cause osteoporosis and pneumonia.

Absolutely. Oh yeah.

Huge, huge.

Huge. Yeah. And I actually, I am really surprised that these things are over the counter. They really should not be over the counter.

Yeah, no, I remember, I've talked about this before, but I remember when I was in medical school, the rep, this just came out and the drug rep was like, these are super powerful drugs. You never want to give them more than six weeks. They're designed to treat ulcers after six weeks. You got to stop them. Don't take them long term. And now people eat them like candy all day long every day. And I'm like, this is not good. And we see so many complications from that. So if your irritable bowel is there and you have these acid blockers that you're taking, there might be a correlation. So we talked about SIBO and we talked, we could talk about how to treat that, but essentially it's Killing the bad bugs and reseeding the gut. And. And what other things are driving irritable bowel besides that?

Well, also, you can also potentially have problems with part of the intestine that causes peristalsis. So normally, you think of the gut is like this conveyor belt. It's always moving things through. So you eat, and within about 24 hours, everything should sort of move through. And there are some patients, especially with patients who have problems with constipation that will have problems with motility or really motility disorders. And there's a test.

Not moving down.

Not moving down. And there's a. There's a part of the intestines which is called the migrating motor complex. And you can actually test for antibodies against the migrating motor complex. It's called IBS Shore test. And I'll do that.

It's almost like an autoimmune.

Yeah, it's a little bit like a paralysis, if you will, or a weakening of the gut. And we talked about that earlier, how in some cases, you'll have patients who have Lyme disease. I actually had a very good integrative gastroenterologist who brought my attention to this, is that he had a lot of patients who had refractory sibo. Yeah. So Sibo was one of those things where it sometimes can come back and oftentimes does come back. And what he was finding is that some of his more difficult patients with refractory SIBO actually had underlying Lyme disease. And Lyme disease affects the nervous system. He tied the two together because there is a paper. It's called Bell's palsy of the gut. And in fact, Bell's palsy is where you get facial paralysis. And I'll never forget this. When I was in my private practice, the first time I saw a real acute case of Lyme disease, the patient presented with Bell's palsy. So her face was paralyzed, and I did testing on her, and the patient had acute Lyme disease. And that is one of the known complications. And it's thought that also that Lyme disease can actually affect the gut, and you get paralysis and. And decreased motility of the gut.

Yeah, so. So that is a very important point, because, you know, there are the typical things that go on. Food sensitivity, gluten, dairy. Some people react to the chemicals in food that are food additives.

Food additives, food colorings, food colorings, sugar, alcohols, people, emulsifiers.

Emulsifiers. All these things that are in our junk and processed food do have a huge impact on people. There's obviously the sibo. So many people get parasites.

Yeah, little. Little microscopic hitchhikers.

Yeah, and there's. There's one called blastocystis, which is really common. It doesn't. It doesn't cause a horrible disease, but it can cause irritable bowel. And about 30% of people with IBS.

Oh, yeah. I. I want to venture to say that I have picked up a lot of these. I call them little microscopic hitchhikers. And when you actually look in the. In the mainstream literature, they, you know, they basically say that, you know, a lot of these, you don't need to treat it. So there are times when somebody can, you know, they have diet Amoeba histolytica and blastocystis and sometimes endolimax Nana. And sometimes people will have these and have a small amount of them, and they may not cause any symptoms whatsoever. But if I find them in the. In the stool test and patients are having symptoms, I treat them.

Yeah, absolutely. And then. And then there's also other things people have, like enzyme deficiencies. We can see on stool tests. They're not digesting their food well. And also, you know, for me, I. I had terrible irritable bowel, you know, almost 30 years ago. It was from mercury poisoning, because mercury affects all your enzymes. It basically interrupts the enzyme function of many different enzymes throughout your body, including your gut. And until I got rid of the mercury, my irritable bowel wouldn't go away no matter what I did. Yeah, I just ate turkey and broccoli and brown rice for six months and nothing worked.

And that's. And that's.

And so you have to keep being a detective and thinking about what are all the variable causes. And we look at the stool testing, we look at breath testing for bacteria overgrowth. We look at organic acid urine testing to see if there's markers of bugs in there. And we sometimes dig down deeper to look at things like metals or Lyme or other tick infections. So there is a real deep thinking about what is going on with this person, and it's guided by their history.

Right, Exactly. Yeah. And it's personalized. It really is. It's, you know, it's totally personalized, and it takes time to figure that out. Yeah. And, you know, sometimes it may take several visits. I mean, you and I have had patients where we've been seeing them for a long, extended period of time, and they're, you know, they're. They make some progress, they get better. They may backslide, they may, you know, then they'll have incremental things. So we sort of uncover the. As you say, the layers of the onion.

Yeah, no, it's true. I had a very bizarre case once. I just reminded me of who was suffering terribly from digestive issues for years and years, was overall systemically inflamed. And it turned out he had Babesia, which affected his gut.

Wow.

He also had histamine intolerance.

That's another one.

There are histamines in food. And so we put him on a low histamine diet, which treated.

His Babesia, and his symptoms got better. So sometimes it's a little bit of a roundabout way to think about it, but what. What case have you seen in your practice that have sort of stood out for you around irritable bowel?

Oh, I recently had a patient who came in with a diagnosis of irritable bowel. You know, that was. That was the official diagnosis. And interestingly, she gave me through the history that, you know, her symptoms seem to have been triggered when she had Lyme disease. And her Lyme disease also was complicated by pots, which we've talked about before, which is postural orthoconic orthostatic tachycardia, which basically means that you have autonomic nervous system dysfunction as relationship to Lyme. So that sort of means when you.

Stand up, you get dizzy.

Yeah, when you stand up, you get dizzy, and your heart starts going really fast. And so, you know, there are certain. A couple of things that, you know, that make me think about Lyme disease. So when I have a patient who's got pots, and sometimes people just come in, and that's their only. Their only diagnosis is pots. I said, okay, well, why do they have pots?

I love medical terms. Postural orthostatic hypotension, which is called pots. It sounds like a fancy diagnosis. What does it mean? It means when you stand up, your blood pressure drops. Doesn't tell you anything about why or what caused it. And it's just. It's, like, so frustrating to me that nobody keeps thinking about what's going on here with these patients so they can actually fix the problem.

Right, right.

So.

So this lady had this history of Lyme and pots, and then she ended up having cancer of the uterus and went through radiation. She was supposed to get, like, 25 rounds of radiation. She had to stop because she developed diarrhea and called radiation colitis. Radiation colitis? Radiation enteritis. Exactly. And believe it or not, the doctors who were treating her said, oh, that has nothing to do with your symptoms. I mean, they literally, you know, they didn't want to. They didn't want to, you know, admit.

That it was from the radiation.

Exactly, exactly. Yeah, yeah. And then she came in and she actually had had some testing done previously. And what I, and I think the doctor who actually did the testing didn't know what, how to interpret the test properly, but the patient's calprotectin was elevated. So calprotectin is a biomarker in the gut. It's. I call it like CRP of the gut. So we have this, this compound which is called high sensitivity C reactive protein. When it's elevated, it is a biomarker of systemic inflammation, and it's also highly correlated with heart disease. And calprotectin is found in the gut and it's sort of like the CRP of the gut.

So when you see that, you see it's high inflammation.

Yeah, exactly. That tells you. And usually, you know, for classic, you know, what we call irritable bowel syndrome, you don't usually have inflammation per se. There's not really dramatic inflammation. There's dysfunction, but there's not inflammation. So her irritable bowel was actually partly inflammation. And I think that was one of the big things that was driving it. The other thing in this particular patient is that she had on her testing undetectable. Akkermansia mucinophilia.

That's a big word.

All right, so. So this is a, it's a mucus loving bacteria. And what we found is that higher levels of this is correlated with leaner body mass, less chance of obesity, less chance of diabetes. And it's also, you want to have higher levels of this because it's a protective good bug. It's not, it's not, it's not a probiotic.

Immune disease.

Yeah.

Increased risk of cancer.

Yeah.

So.

And it's not a, it's not a bug that you can go out and get a pill for, at least not yet. Eventually we might because it's so beneficial. But what we find out is that this particular bacteria feeds on fibers, specifically polyphenols.

Polyphenols are those compounds that are phytonutrients found in lots of colorful fruits and vegetables like pomegranate and green tea and cranberries. Cranberries, yeah.

So your little bugs like cranberry, pomegranates and green tea.

Exactly. They love that stuff. This is their, you know, I call it the miracle grill. You know, that's a miracle. You put this stuff on there and the good bugs flourish there's.

A fairly new understanding, you know, because we thought, okay, you need prebiotics, you need probiotics, but I think the polyphenols are also critically important to optimizing your gut flora.

The three Ps, yes, exactly. And, and the, the other thing which I always come back to when I, when I think about the digestive tract is, is it's a beautiful visual, is the rainforest. And for anybody who knows about rainforest, rainforests are full of biodiversity. There's lots of flora and fauna. There's frogs, there's birds, there's all different plants, insects, worms. And the more biodiversity that you have in your personal internal rainforest, the healthier you're going to be. And there's, there's, there's tons of studies that have shown this and it's a, it's, it's nonlinear, it's very, very complex because there's this whole ecosystem and there's this cross feeding and interaction that happens when you have a diverse internal rainforest.

Yeah, it's so true. You know, I was talking to professor at Harvard who's a psychiatrist and also runs the department of nutritional psychiatry and she's written a book called this is your brain on Food, talking about the microbiome and its effect on psychiatric illness.

Absolutely.

So we, we used to think that, you know, the crazy person would have the gut problem. Turns out the gut problem, people have the crazy thing upstairs because of the gut thing. And fixing the gut fixes the depression, anxiety, ocd, all these crazy things that we thought of our psychiatric illnesses. Turns out they're really related to the imbalances in the microbiome and the lower diversity. And Western societies have increasingly lower diversity.

Oh, huge. Huge. Yeah, exactly. And it happens very, very early on. And what typically will happen is.

There are some people that.

You know, they're very picky eaters and they will, they'll be eating the same food over and over and over. And you know, I always tell patients that, you know, you want to try to increase your intake of diverse fruits, vegetables, you know, try to eat. And see right now in the Berkshires, you know, we have lots of great vegetables that are available that you may not get year round. And you know, eating, I call it, you know, you want to eat a crayola crayon box. The more color you have in your diet, the healthier your diet's going to be.

And I want to come back to something you said before about this inflammation in the gut. There's a whole new phenomenon we call pre inflammatory bowel disease. So we thought irritable bowel wasn't inflammatory. It turns out, even if you can't always detect it, it tends to be very inflammatory. And there are. There are cases like you saw of people with this pre ibd. So it's like pre Crohn's or pre colitis.

Yeah, it's not like one. One night you wake up and all of a sudden you got Crohn's disease. Yeah.

So there's this level of this marker, we check, and it's often elevated, and people have, you know, not full blown Crohn's, but something's going on in there that's driving inflammation. They have to deal with those factors.

Exactly. Yeah, exactly.

So. So this patient also said elevated gluten antibodies. Right. So she had this low akkermansia. She had.

Yeah.

Elevated, elevated gluten antibodies and this high calprotectin.

Yep.

And so this is a sort of a perfect setup for having a messed up gut.

Absolutely. Yeah. Yeah.

So how do you. How would you take care of this patient then who came in with the gluten issues, the low akkermansia, and the calprotector?

Well, I mean, to. To address the inflammation.

And by the way, these are something that your traditional doctor will never look for, that we usually look for in functional medicine at the ultra wellness center. Sort of standard operating procedure for us to really look at these things. Yeah, so.

So, you know, to treat inflammation, I always like to check the omega 3 fatty acids can. When you have low essential fatty acids, you're a setup for inflammation. So in this particular patient, that patient had suboptimal omega 3 fatty acids, which are related to eating cold water fish. So I got her to take some supplemental omega 3 fatty acids, had her increase her fish intake. I used an anti inflammatory.

Supplement called ultra Inflammax, which has. It has a powder, curcumin, and other things to help decrease inflammation in the gut.

Ginger.

Rosemary. Exactly. Ginger and rosemary. Exactly. And then also used Enteragam, which is a immunoglobulin that helps with patients who have sort of diarrhea type. That's actually a prescription medication.

So. So tell us more about what it. What is this immunoglobulin stuff? Because you hear a lot about it and yeah, it's.

It's serum bovine derived immunoglobulin, and it's basically colostrum. Yeah, you can think of it as like colostrum. And yeah, colostrum is, you know, colostrum is that stuff that in mother's milk that's is before the milk comes on.

And it gives immunity to the baby.

Exactly. Yeah. It's passive immunity. So it's the mother's immune system that's passed down to the child. So, which is really quite amazing when you think about, from an evolutionary standpoint, that the mother's immune system has evolved and learned what to deal with and how to deal with it. And then that immune system gets literally transferred in the breast milk to the.

Baby until the baby can actually develop its own.

Exactly, exactly. And the interesting thing is our immune system has to learn. It's got. It's got to be. It's got to go to school. Yeah. And that's why, you know, when you see these little kids who are crawling around on the ground and they're putting stuff in their mouth, we're developing what's called mucosal tolerance. It's the immune system learning to deal with the planet Earth. And it's, you know, it realizes that, okay, you're going to be around a lot of these things. You don't want to overreact to it. And so, you know, we always talk about, you know, what is a healthy immune system? Well, a healthy immune system is a tolerant immune system.

Yeah. It doesn't overreact or underreact.

Exactly. That's. That's the key thing. And I always say to people, I want a strong immune system. Well, if you have a too strong immune system, that's called autoimmune disease.

Right.

When your body's reacting to everything and it's, like, overreacting. So having tolerance and mucosal tolerance is really, really important. And the other thing, which I. In some of the lectures I do, and I like to emphasize this, is you can think of, you know, we have the Boston Symphony Orchestra, and unfortunately, Tanglewood is not open this season because of COVID But in the Boston Symphony Orchestra, you have the conductor, and the conductor, you know, balances the woodwinds and the strings and everything, and they sort of keep everything in balance. And in the immune system, we have cells called the T. Reg cells. And the Treg cells regulate the immune system between the various parts of.

To, like, make sure it's not too hot, not too cold.

Exactly, exactly. And guess what helps with Treg cells? Fiber.

What?

Fiber. Yes. So that when you're eating lots of fiber, you upregulate your T. Reg cells. Other things that can do that. Vitamin A can do that, too. But fiber is probably one of the biggest things that helps with the Treg cells.

Yeah. And functional medicine Is really.

Practical, too, because when you have a patient with any condition, particularly with gut issues, which is often driving so many things. So even if you don't have, quote, irritable bowel, a lot of health conditions are driven by imbalances in the gut. Like we talked about, psychiatric issues, heart disease, obesity. But we have a very specific framework called the 5R program, which we use to methodically treat and restore gut function. And we've been doing it for decades. Even before people called it the microbiome, our goal was to really optimize the microbiome as a way of treating all sorts of diseases. So how. How would we do that? In this patient, Obviously, you got rid of the gluten, right?

Yeah, yeah, obviously. In a patient. In a patient, to decrease inflammation, you can decrease the foods that, you know, typically drive inflammation. So things like trans fats can drive inflammation, sugar drives inflammation.

Dairy, big thing, especially cow's milk. Sheep and goats tend to be less inflammatory. I'm not sure why that is.

The A2 casein.

Oh, ET case. Okay, that's it. There you go.

A1 casein is very inflammatory, which is. All the modern cows, all the heirloom cows and sheep and goats still have a 2 casein, which is less inflammatory. It tends to cause less digestive issues for people.

Yeah. And then gluten is a big driver. And then other things that, you know, are found in foods, like we talked about, things like emulsifiers and artificial processed foods. Processed foods, exactly. If you can't read it on a label, don't eat it.

Yeah, yeah, yeah.

You don't. Don't need it. Another one, which is. I'll mention this is titanium dioxide.

Yes, I was just reading about that.

Exactly.

Tell us about that.

Yeah, it's bad. It's the thing that they add to food, to white, even white whitening. And they'll use it in a lot of products, gums. They use it and such.

It's in a lot of vitamins you get at the. At the drugstore, too.

Exactly. And. And titanium. Your body does not like titanium. It's not. It's a metal, and your body can react to it. And it's. It's almost like a nanoparticle metal that you're putting in the body, and it's been shown to the gut does not like it.

Yeah. One more reason to not eat processed food.

Exactly.

All right, so. So you've gotten. Removing the foods. We're removing these processed ingredients, Removing trans fats, gluten, dairy, other food sensitivities. I had a patient with, for example, I had diarrhea for years and years. She had a sensitivity to eggs. It wasn't an allergy. She got rid of the eggs and her diarrhea went away.

Yeah. You know, and then there are some times where, you know, doing a strict elimination diet to try to tease out because food is complex. There's lots of things when you're eating food. There are also some, some patients that you. I know you've probably done it yourself, where sometimes you've got to put them on what's called an elemental diet, where you basically give them a pre digestion. Pre digested. Exactly. And that helps us sort of calm down and quiet the gut. In fact, mainstream doctors will do that for patients where they'll, they'll actually put them on parental nutrition where they just give them it through the. They sort of rest the gut.

Yeah. I mean, we're gonna be having a podcast with one of our nutritionists. We'd be talking about the elimination diet and why we do it and how we do it. And there's lots of different versions, particularly for ibs, the fodmap diet. There's a specific carbohydrate diet, there's traditional elimination diet. So I think, I think this is a, in. A really important thing is to get rid of the things that are causing the problem. And then we look for parasites and other bad bugs. Sibo breath testing. So we actually clear out all the bad stuff.

Yep. Yeah. Take out, take out the bad and put in the good.

What's the next step for how to repair the gut on the 5R program?

Well, you can, you can reinoculate you. Sometimes you can use probiotics along with prebiotics. We call that synbiotics, though. The big thing you got to watch out with that, and you probably seen this is if you add that in too soon, you can actually sometimes flare up bloating symptoms.

Yeah, it's like a war between the good guys and the bad guys. You got to clear out the bad guys first. I call it the weeding, seeding and feeding program. First you got to do the weeding, then you got to see the good guys and you got to feed them.

Yeah, exactly. Yeah, that's exactly right. And then the other thing that's also important, just that sort of helps with digestion is, and I've been using this more and more, is stimulation of the vagus nerve. So the, the vagus nerve, we have the autonomic nervous system in the body. And there's like my analogy is the gas pedal and the brakes. And the gas pedal is a sympathetic. So it sort of gets things going and the brakes sort of slow things down. So the stimulating of the vagus nerve is resting and digesting. And that's what you want to be doing. You want to be in a relaxed state when you're, when you're digesting your food. And we tend to have a sympathetically driven society, you know, running, going, we're, you know, always on the go.

Some people say prayers are grace before eating to calm everything down. Yeah, right.

Yeah.

And we just kind of eat on the run, eat on the car.

Yeah.

People walking down the street, and we.

We'Re all guilty of that.

People watching tv.

Yeah, that. The worst thing is actually I call unconscious eating. You know, it's like you're sitting in front of watching a movie and you get the popcorn, all of a sudden the big bowl's gone.

They've actually done those studies where they literally have a secret trapdoor on the bottom of the bowl and they, like, fill it up from the bottom and people just keep eating and eating.

Exactly. Unconscious eating. It's like it's stop. Exactly, exactly.

Okay, so. So the 5R program is basically remove the bad stuff, basically replace the things that are missing.

Digestive enzymes.

Enzymes and prebiotics. Reinoculate and then repair, which is the next phase, which is how do you fix a leaky gut? Right.

Yeah. And that, that's, you know, you talked about butyrate. Butyrate is one of the things that's very helpful for leaky gut, and I've been using that in. In supplement form. Yeah. I also encourage, you know, fiber. Fiber use. And.

Glutamine can be very helpful. Aloe is, can be really helpful. Quercetin or other. Other things.

Vitamin A, Zinc.

Yeah, zinc. Zinc in the form of zinc. Carnosine is also. There's some really interesting studies on that with leaky gut because when you take things like Advil or Aleve, those things cause transient leaky gut, gut. So you're going to have, you're going to develop leaky gut. And for people who are taking them chronically, they've shown that just taking zinc will help repair the gut with the NSAIDs.

So it's really a very specific methodology of diagnosis and treatment. And, and, you know, the hit rate is pretty high on this. I mean, I, I think, you know, people come in with these chronic, lifelong digestive issues. I just talked to a patient yesterday, and she'd been struggling, struggling, struggling. Didn't know she had A parasite. She had bacterial heart grow. She had all these issues, and within a couple of weeks she's back to normal. And I think people are just sort of shocked. And one of the things you use in this patient is a gut shake that kind of combines a lot of these things that help grow her. Akkermansia.

Exactly. Yeah. So the gut shake is full of polyphenols, contains things like cranberry, pomegranate, maca.

Matcha.

Matcha. Matcha. I call matcha green tea. Matcha. Matcha. Right, right. Matcha. No. Oh, my God.

Yeah, yeah.

And.

And it's got the immunoglobulins which are talked about that help kind of regulate the immune system in the gut.

Right.

And prebiotic fibers. Probiotics.

Yeah. And I, again, this, I call this sort of like, you know, miracle grow for your rainforest. It just helps with biodiversity. It helps with this flourishing of the good, good guys which, which have their own way of, of keeping things in check. It really is.

So for those listening who have irritable bowel, who've been suffering for a long time without help, there is help. You don't have to suffer. It's actually not that hard to fix. It's sort of embarrassing how easy it is once you know what to do. But most of us in medicine, we're not trained on how to approach this systemically or systematically. And that's what functional medicine is. It's a systematic approach that looks at the causes and then restores normal function. Hence the nerve named functional medicine. And we've been doing this at the Ultra Wellness here for, gosh, I don't know, decades now with all of us together, we probably have 65 years of clinical experience and we all are faculty and teach all over the world. So I think your, you know, your, your stories and my stories just, you know, go back so many years and help us really know that we have a way through this and people don't have to suffer.

If you love that last video, you, you should check out the next one for sure. On getting to the root cause of all disease. Functional medicine is about getting rid of the things that impair health and putting in the things that help the body thrive. And then the body can take over and with this amazing intelligence, can repair.