Fix Your Gut, Heal Almost Everything!

Coming up on this episode of the Doctor's Pharmacy.

So many people are coming in with digestive issues and symptoms of inflammation in their body. It's really common. Even if people are coming to us for other reasons, we're seeing, okay, we've gotta start with the gut and pay.

Attention to what's going on there.

Hey everyone, it's Dr. Mark. Time is our most valuable asset, and Rupa Health understands that better than anyone. They've created a game-changing solution to simplify lab ordering for functional medicine practitioners like you with Rupa Health's online portal. you can access over 3000 tests from dozens of lab companies like Dutch, Doctors Data, Mosaic, Genova and Access Medical Laboratories, all with just a few clicks. That means no more headaches or administrative nightmares that come with traditional ordering processes. Plus, you'll only receive one invoice for all your tests, making life easier than ever before. And the best part, it's completely free. That's right, there's no hidden fees or complicated billing system, just one invoice paid online and upfront. So start saving time and energy by visiting RupaHealth.com, sign up free and take control of your lab ordering process today. That's R-U-P-A-Health, www.health.com Over 1500 years ago, Hippocrates, known today as the father of medicine, said that all diseases begin in the gut. Now, as a functional medicine practitioner, I agree with him. And one of the ways I ensure my own gut stays healthy is with AG1. Their formula includes bioavailable pre and probiotics, which promote diversity in the gut microbiome, helping your entire body absorb nutrients more efficiently. I drink AG1 every day, and ever since I started, I have consistently felt better and my digestive system feels calmer and supported, which is a huge win. I just add a scoop to water in the morning and I feel the effects all day long. We have an exciting new offer for my listeners. Right now, AG1 is offering my audience a full year supply of their vitamin D3K2 liquid formula free with your first purchase. They're also going to give you five free travel packs as well. Just go to drinkag1.com/hymen to get your free supply for a year of vitamin D3 and K2 and five free travel packs with your first purchase. Again, that's drinkag1.com/hymen.

Welcome to Welcome to Doctor's Pharmacy. I'm Dr. Mark Hyman. That's Pharmacy One F, a place for conversations that matter. Today we're going to talk about gut health. Functional medicine is about digging to find the root cause of what's going on with your body, not just treating the symptoms. And as a physician, when I do that digging, I often end up looking at the gut and the gut health of my patients. It's the epicenter of the body where 60% of the immune system resides. When we work to heal the gut, symptoms often resolve and the entire function of the body improves. In today's episode, we feature three conversations from the Doctor's about why healing the gut is necessary as the first step to improve chronic illness. I talked with Dr. Elizabeth Boham about intestinal permeability and inflammation. I talked with Dr. Raja Dhir about what to look for in probiotics. And finally, I talked about irritable bowel syndrome or IBS and why it's so.

Prevalent and how to treat it. Let's jump in. Today we're going to talk about leaky gut, which is something that is starting to be in the awareness of traditional medicine. But they still don't have a clue how to diagnose it and how to treat it. So tell us first, what is leaky gut?

Yeah.

So, so many people are like saying the word leaky gut, leaky gut, but officially, right, the official medical term is increased intestinal permeability. And I love to draw a picture for all my patients when they come in to really show them what we mean by increased intestinal permeability.

Yeah, I failed art in the eighth grade, so I just show them Google images.

I don't know. Oh, that's good.

That's good.

I don't know. I'm still I'm drawn at each time. I don't go to Google Images. That's very smart. So we know there's this one cell layer, right? There's that one cell layer, the endothelium, that divides the inside of the intestine, right? So where the food is and all sorts of other things.

The intestine- basically your GI tract is a tube that's literally outside of your body.

Right.

I mean, it's a protective tube that you put food in, all that stuff.

Goes in, it comes out the other side, and it's literally like not really part of your body in the sense that it is.

Right.

The stuff inside isn't yet in your body, right?

But there's that cell layer that has to determine what should come into my body, right? And what shouldn't. What's been properly digested food, you know, has this protein been broken down enough yet? Should I absorb this or should this stay out? So that barrier- It's like a filter.

It's like a coffee filter. You don't want the grounds getting into your coffee, but you want the good stuff getting in. That's sort of how your gut and when it does, it's like you have holes in your coffee filter and stuff leaks through. And why is that a problem?

Right, because that stuff leaking through, that might be a food particle that's not digested enough yet, or it could be a bacteria or a bug, a fungus, or something that shouldn't be getting into the body, some of the not so good bacteria. And when those things that get into the body when they're not supposed to, then they can trigger all sorts of other symptoms in the body. And that might be symptoms of inflammation. So somebody might feel like joint pain or asthma, congestion. And there's been a lot of studies to show this. It can trigger autoimmunity. Yeah.

Right.

Allergies, autoimmunity, asthma, all kinds of fibromyalgia.

Yeah.

But we know what's interesting is that most diseases that are chronic diseases are inflammatory diseases. Yes. Right. Heart disease, cancer, diabetes, Alzheimer's. stroke. I mean, these are all inflammatory diseases. Even depression is an inflammatory disease of the brain. ADD is inflammation of the brain. Autism is inflammation of the brain. And so what's really interesting about this gut issue is that when the barrier breaks down and you're basically like an area the size of a tennis court, if you lay your intestines out flat and it's like, you know, one cell thick. So you're basically one cell away from a sewer, you know, on the other side. It's an important cell, right?

Yeah.

And that can get damaged. And when that does, things leak in, like you said, and you've got 60% of your immune system right under that layer. which then reacts to whatever's coming through that's not supposed to come through. So your body's actually doing its job creating inflammation. It's just that your gut's leaky and.

The stuff getting in, you shouldn't be getting in. Right. And then you start to not feel so good, right? Like you mentioned fatigue or brain fog or joint pain or swelling in the body. We see a lot of people holding onto water or swelling or congestion or asthma.

And then that whole cycle of autoimmunity.

Yeah.

So it's really, you know, one of the most prevalent problems. And so why are we having all this leaky gut problem?

Oh, right. That's a great question, right? So much because of our crummy food supply.

What do we know about that? Yeah, listening to me, that's all I talk about.

Our crummy food supply that we've been putting a bunch of pesticides and antibiotics into, which is just shifting our microbiota.

And I mean- Glyphosate from- Yes. the Roundup, the weed killer that's on almost all our GMO foods and even wheat products is one of the biggest damagers of your microbiome. Forget that it causes cancer, whether you can argue that or not, but it does disrupt your microbiome.

Right.

And, you know, we, of course, are trying as physicians not to prescribe as much antibiotics for our patients, but so many of us have taken, unfortunately, too many antibiotics. And then our food supply, right? We're using so much antibiotics in our food supply to grow bigger cows, for example, and that's just shifting that whole microbiota in our gut.

That's true.

And I read a paper recently about emulsifiers in food, which is using all processed food to make it thick or solidify it, hold it together. And these emulsifiers like carrageenan and xanthan gum, and they even have this thing called microbial transglutaminase, which is basically bacteria made gluten, if you can believe that. And the reason it's called gluten is because it's like glue. so it makes things stick together, makes the food stick together, right? But it's highly damaging to the gut. And so you've got all these processed food ingredients in food that are linked to autoimmunity. Yep. Right. So it's not even, and then of course the starch and the sugar, the processed oils all damage your gut. And then of course the lack of fiber, the lack of phytochemicals in our diet, the lack of good foods, prebiotic foods, probiotic foods. Like I had sauerkraut for lunch yesterday. I mean, we don't eat that stuff. And It's so important and we've seen so much damage to our gut because of all of these various factors in our diet. And then of course there's the acid blockers that we take for everything. Antibiotics, as you mentioned, hormones can mess up your gut bacteria, steroids can do it. And so you end up with antibiotics obviously end up with this horrible cascade of people with gut issues.

It's the number one reason people go to the doctor. There's so much of it now. It's crazy, isn't it? So many people are coming in with digestive issues and symptoms of inflammation in their body. But it's really common. Even if people are coming to us for other reasons, we're seeing, okay, we've got to start with the gut and.

Pay attention to what's going on there. Functional medicine has been thinking about this for decades. And now there's the microbiome revolution, everybody's talking about it, there's huge industry development around it, and we're talking about probiotics and this and that. And we've been focusing for decades on the simple fact that most of our chronic illnesses start in the gut. And whatever the name of the problem you have, whether it's migraines, or whether it's depression or whether it's diabetes or obesity. I mean, I had a great- Rheumatoid arthritis. Rheumatoid arthritis or autism, whatever, you gotta start with the gut. And traditional medicine, like leaky gut is not a thing. You go to the doctor, if you have arthritis, they're like, how's your gut?

Right.

Go to your cardiologist, how's your gut?

Even though there's so much research showing the connection. We don't get trained. And so, it's this huge gap right now where the science has advanced so far, but the practice hasn't. And in functional medicine, we've been really great at actually getting the memo that the gut is at the center of our health. Right, so for years, right, we've learned.

About that five R program with functional medicine and how helpful that can be to heal the digestive system and then heal all these symptoms or diseases that somebody has. Yeah, I mean, it's amazing.

I was talking to the CEO of Cleveland Clinic recently and was telling you about studies that he'd heard about. that had used fecal transplants in autistic kids and taking the poop out of a healthy kid and putting them in an autistic kid and the kid's autism goes away.

It's phenomenal.

I mean, that's not true for all kids with autism. But it's phenomenal. Yes, it's amazing. Or they're doing transplants from people who are thin to people who are diabetic and their blood sugar gets better.

Right.

I mean, I had a guy once who was a really great patient and he was very poorly controlled diabetic on lots of medications. And we worked on his diet. It helped a lot. took it down from like 200 to like the 120s or so. But I never could get it all the way down. It was a really good diet and exercise. And he was telling me he had a bunch of digestive issues. And so I said, you know, why don't you take some charcoal and do this and do that? And he called me back. He says, I don't know what happened, but my blood sugar went to 90.

Right.

So we absorbed all the toxic crap in his gut that was causing inflammation that was causing his blood sugar imbalance. These are the kinds of things that we do every day in functional medicine, but that are not part of traditional care and people are missing out on.

Right. When we're saying, why is this going on? How do we get to that underlying root cause for that individual person?

So you've got some amazing cases, and I'd like to sort of get into it because people don't understand how so many of our issues come from the gut and how easy it is to diagnose it and treat it. And we use tests that traditional doctors just don't do. like we have a different set of filters that we can sort through information and data and ask questions that traditional doctors can't. Like how do you measure a leaky gut? How do you look at the microbiome in the gut? How do you look at the digestive function in the gut? How do you actually start to treat it in a different way? And I think your first case is just so rich with story that is so common that I just love you to share this because I think everybody's gonna resonate with this story. And by the way, I have never seen this patient as your patient. But I have literally seen the same story a hundred times or maybe 500 times or a thousand times in my practice. It's the same freaking story, right? So tell us about this story.

So it was a 24-year-old gentleman who came in to see me, was really struggling over the last year with his digestive system. He was having a lot of bloating and gas, pain in his stomach. Every time he ate, he was having diarrhea, and sometimes he was getting constipated, and he went to his Dr. Traditional GI doctor, and they told him, you have irritable bowel, but he wasn't getting any better, right? Because he was having so much stomach pain, he had lost some weight. So he wasn't on the thin side to begin with, but because he was having stomach pain when he ate, he wasn't able to eat as much. And he was even losing more weight. He was feeling really weak and tired and sad, depressed. And so for everyone, the timeline is so important, right? That's what we learn in functional medicine is that gathering that information, learning about that individual patient's story.

We start with a history with the mother and her pregnancy and the birth and whether they breastfed and when they took antibiotics, whether they were sick as a kid, what happened when they were introduced to food, when they got gluten, when they got dairy. We ask all these questions. So when someone comes in with irritable.

Bowel, the average GI guy is not asking all these questions. So why do we ask all those questions? So, you know, because for this gentleman, for example, he really didn't have stomach pain before a year ago. But what we found out is that when he was a kid, he had ear infections. Probably because he was eating dairy. Probably, right? So it's such a common connection.

Oh my God, I remember months being in the ER, Liz, and this patient came in and this little boy was coming back and over and over to the ER with ear infections and just so inflamed. And I said, did you breastfeed?

Yeah.

So when did he start getting the ear infections? Well, we started formula and dairy and milk. And I'm like, oh, okay. And this is even before I knew about functional medicine. I know.

And I was like, well, maybe you shouldn't eat dairy.

Yeah, the kid was fine, you know?

Right.

That's such a common connection. I mean, even my son with when he started dairy, he got asthma and eczema. It's unfortunately such a common connection. So for this child, he had a lot of ear infections and eczema. And so he was on antibiotics about once or twice a year in his childhood. And he really didn't think that was very much. He's like, that wasn't too much. But it makes a huge impact on the microbiome as we're learning. And then he started to have acne as a teenager, maybe because of dairy more, right? Or the imbalances in the microbiome. Right.

If he screwed up the gut with antibiotics or a C-section or lack of breastfeeding, then you get often more acne. Yes. We treat acne from the top in as opposed to the inside out, which.

Is actually where it works much better. And this gentleman was given low-dose antibiotics for two years. So then he took even more antibiotics. and so this history of antibiotics sort of set him up. And about a year ago, he had some probably viral stomach infection. And then since that time, he started to have all these digestive issues and was losing weight. And so- which is a common story.

People are- so common.

You have like this sort of smoldering.

A bunch of insults over the course of their life. Maybe they're a C-section, they had antibiotics as a kid, they took acne antibiotics, they were eating a crappy diet, whatever. and all of a sudden something happens and then boom, the body can't take it anymore and it creates some kind of disease. Yeah. But if you look at the story.

You can often map out exactly how this happened. That connection with his acne, with his asthma, with his digestive issues, with those antibiotics, that's that story we often see.

And we're not making this up. There's so much science that shows that your gut microbiome plays a role in acne and eczema. We're actually doing this in clinical clinic now. We're studying asthma and looking at how the microbiome plays a role and how it affects inflammation, all these various factors.

That most doctors just don't pay attention to.

Right.

So with him, as we do with most of our patients, we do food first, right? So we said, okay, we've got to really focus on this person's diet and help him start feeling better right away so he can start to eat more and regain some of his strength. So we pulled away inflammatory foods. We took them off of gluten and dairy. Sometimes we will do some tests that look at celiac disease.

Which is a big cause of leaky gut.

Yep. that's for sure. Probably the number one.

And he didn't have that. By the way, you don't have to have celiac disease to actually have a problem.

Right.

You can have they call non-celiac gluten sensitivity. I would estimate it probably affects 20 of the population. And I think if you look at the antibody levels, you can get a clue, which most doctors don't look at. And I read a study that autistic kids and schizophrenic patients often have 20 of them have antibodies to gluten. and it may not be full-blown celiac.

And even if people are negative totally for celiac, if they have increased intestinal permeability, they start reacting to a lot of different foods. So then you start to see with that leaky gut, as we talked about before, right? The coffee filter and things are coming through. Then the body's reacting to lots of foods that it maybe never reacted to before.

So they're not true allergies. They're more like sensitivities.

And because of, and the real thing is it's because of this increased intestinal permeability. So our job is we have to heal that increased intestinal permeability so that they don't have to be so restrictive with their foods. I mean, we still always want them to be on a healthy diet, but we want to relax those restrictions over time. We, most of the time, we can.

Hey, everyone, it's Dr. Mark here. Over 1500 years ago, Hippocrates, known today as the father of medicine, said that all diseases begin in the gut. Now as a functional medicine practitioner, I agree with them. And one of the ways I ensure my own gut stays healthy is with AG1. Their formula includes bioavailable free and probiotics, which promote diversity in the gut microbiome, helping your entire body absorb nutrients more efficiently. I drink AG1 every day, and ever since I started, I have consistently felt better and my digestive system feels calmer and supported, which is a huge win. I just add a scoop to water in the morning and I feel the effects all day long. We have an exciting new offer for my listeners. Right now, AG1 is offering my audience a full year supply of their vitamin D3 K2 liquid formula free with your first purchase. They're also going to give you five free travel packs as well. Just go to drinkag1.com/hymen to get your free supply for a year of vitamin D3 and K2 and five free travel packs with your first purchase. Again, that's drinkag1.com/hymen.

With probiotics, there's a lot out there. And what's important to think about, if people are trying to choose a probiotic, how do they evaluate it? For example, for when people are choosing a vitamin, I'm very clear with them. They need to make sure that the product is in the right form. So in other words, the right version of that nutrient. For example, if you're taking folic acid, maybe you need five methyl folic as opposed to just folic acid. Or if you need magnesium, maybe you need magnesium glycinate or magnesium threonate instead of magnesium oxide, which isn't well absorbed. Second, you need to make sure that what it says on the label is actually what's in the bottle. That things are third party tested to be there for both purity and potency. There's no contaminants or toxins, and it actually is what it says on the bottle. That there's no weird stuff in it, like allergens, fillers, excipients, colors, dyes, sugar, lactose, gluten, all that stuff can be in vitamins. It has to be bioavailable in terms of the form. It also has to be absorbable. So if it's in a crushed tablet that's under tons of pressure, it might be the right everything, but he may not digest it. So how do we think about probiotics? Should we be taking hundreds of different strains? Should we just take one? How do we know what's good? How do we know? I mean, I could buy something in the store.

It says 50 billion units on the bottle. Is it actually that?

Like, how do we know?

It's a very simple rule of thumb for people is there's two major classes of probiotics. One is targeted for a specific indication. I want to lose weight. I want to improve my mood. I want to signal to improve my skin. You know, they're very different microbes that work on these different axes, and they're usually very specific. So it's not necessarily a bunch of bugs that will do that, but you could find ones that are very targeted that have that targeted effect. And so I think that this is bucket one.

That's an incredible statement you just said was that there are different strains of probiotics that have different effects for different diseases and conditions. And, and some may be good for your skin, some may be good for your brain, some may be good for your immune system, some might be good for your heart, some might be good for your metabolism, regulating your blood sugar. I mean, it's quite interesting, you know, the differential ability to determine which probiotic is good for which thing. And that is something that's pretty new. I mean, it's almost like personalized probiotics.

Well, you're not going to get that from one or two bacteria. And so, you have to either only take one benefit you're looking for, or you have to take a more complex consortia. And so, it's not that you need a hundred strains, but if you want to maximize the outputs, you generally want more microbes adding up together to create broader spectrum effects. So there is a kind of network effect, if you will, going on on which probiotics you take and for what purpose you are taking them. That second category of probiotics is what is your basis? You know, you hear all the time somebody say, I get my probiotics from kimchi or I get my probiotics from a nutritional shake or you get one or two strains of bacteria. KIMCHI ORGANISMS, but you can't say that that is going to therefore be equal to a strain which is proven to signal to the gut barrier or a strain that regulates cholesterol uptake or a strain that works on evacuation disorders to relieve constipation. I mean, all of these are different mechanisms and they're coming from different strains. It's why, again, I want to emphasize consortia are so important. And when you say consortia, you mean.

A lot of different strains that have different functions.

A lot of strains. together.

So, keep going on how we know to pick the right one or the right strains.

So, now you've kind of asked your first sequence of questions. Do I want a broad spectrum consortia for many different things or do I want something more targeted? From there, you need to assess if what you're picking is good. And, there's three layers to it. There's purity, there's potency, and there's efficacy. Purity means that there's the bacteria which are you list, and none others. It's very simple and that's done by very good quality control. So you're sequencing at the level of individual genes, all the bacteria in your product, you know them, you get a fingerprint every time you do a fermentation, every time you do a production, you get a fingerprint and you know that those organisms are there and nothing else is there. And so this is the most important question to ask from a sake of purity potency. is not just what's written onto the label because that can be very misleading. So there's products in Japan that say that we have 1 trillion organisms or a yogurt starter culture from Australia that says we have 1 trillion bacteria. There's kind of your VSL3 kind, your gastroenterologist recommended probiotics that are 300-400 billion where you see these big, big numbers on them, but you know, you have either very high die-off when it comes into your stomach, Right away, even if there's listed eight or nine different strains on the label, it's predominantly one. Like the number one gastroenterologist recommended probiotic has nine strains listed on its label, I believe, or eight, but it's 96% yogurt starter culture and the rest are small, like tiny byproducts. So potency is very, very important, but at the level of throughout the entire gastrointestinal tract is something that I take very seriously.

In other words, you could take a.

Probiotic, looks good in the bottle, everything's in there, but you eat it, take it as a pill, and it gets.

Digested in your stomach and kills everything. Yeah, or what's listed is never even alive by the time it makes it. So maybe you see a hundred billion written on the label, but there's 99% die off and by what reaches the colon. So you're not going to get much organic acid production with 99% die off.

Before it even gets where it needs to go.

So the bacteria, you have to make sure you're taking a multiple. bacteria that all have different scientific evidence behind them. Cause there's a lot of stuff out there that doesn't, but there's a lot of evidence around a number of bacteria that have very specific effects on the GI tract, on immune system, on heart health, on metabolic health, on immune health. So we can use that data to start to design probiotics that actually make sense, right?

It's exactly the approach that I believe is best. Yeah, it's exactly the approach that we took.

Your company is Seed, right?

Yeah, Seed produced a probiotic called DS01, and it follows the design principle that you just stated, which is many different organisms from this similar species that have many different effects on many different organ systems. And so it's a consortia of abundance of it is a very broad spectrum from a microbial genomic standpoint. And this is the approach.

Seed is the company that you are involved with that produces this unique probiotic that is one of the most rigorously studied and for sure the components in our rigorously studied and evaluated in ways that make sure that you're getting what you buy, that what it says on the label is what's in the thing, that it gets in your gut, that it does the right thing. So you have metrics for tracking all that, right?

Absolutely.

We were the first, I think, to do a capsule in capsule system and we had to do about 50 different iterations of this If it opens too late, you miss the small intestine, so you miss some of those immune benefits. If it opens too early, the stomach acid is going to kill a large percentage of those strains. And so it was really an exercise of finding this Goldilocks zone of upper small intestine but complete release of all of your organisms. And this is something that we tested in ex vivo and in vitro models to mimic the entire gastrointestinal system. I think this is very, very important. Some people say that probiotics don't have to be alive to work, but they're not really talking about probiotics. They're talking about something else. I'm not going to rule it out that a dead bacteria could be positive. There's some data I've seen that maybe the immune system still picks up on its cell wall, but it'll never, in my opinion, be more than if that effect is still happening, but the bacteria is also alive and it's able to be metabolically active. And so this kind of targeted release, we were one of the first to do it. I think a lot of people now are trying to follow suit and make a delivery release profile really a new standard. I would love to see people engage more with companies on this type of data because it's very valuable to know where the bacteria are going to go and what percentage of the bacteria on your label actually have a chance of entering into your colon being metabolically active.

Yeah. And the other thing that's unique is you also have prebiotics in there, but they're not the typical kind of prebiotics. They're actually polyphenols, which people don't think of as prebiotics, but I think they're their food for the bacteria. And for example, we know this with Akkermansia that it particularly loves green tea and pomegranate and cranberry polyphenols, and that makes it flourish, whereas, you know, other bacteria might need other things. So how did you come up with this concept of what we call a synbiotic, which is a combination of a pre and probiotic?

Yeah, I remember in 2015 or 2016, the term prebiotic was almost exclusively used to talk about these types of fibers, not polyphenols, not flavonoids, not these other juicy compounds from the plant kingdom, but mostly fiber and types of fiber that were derived. And I think that's interesting. I think that there's a role for it. I think it's not for everyone, but most importantly, I think that the dosage of that needs to be very, very high. If you have a low fiber diet and you want to take it from supplementation, you need a lot of it to have a prebiotic effect. For our symbiotic, and my philosophy on non-fermentable prebiotics more generally, right, or prebiotics that are metabolized by the gut microbiome into these secondary tertiary metabolites, these very powerful molecules, the gut microbiome loves flavonoids and polyphenols, and it's more than just mucin degrading organisms that like to feed on them. You can find pathways in hundreds of different species of bacteria for just basic conversions of these polyphenols. And the reason is that polyphenols are very big molecules. So that was one of our first discoveries is that polyphenols are very large, like structurally, physically, they're very large. And so I think it's less than 5%. I want to say 4%, but I believe it's less than 5% of polyphenols are actually absorbed into your circulation and into your bloodstream directly. And so it's this very, very powerful way to impact the gut microbiome because you're just sending so much of them there and they love it and they break it down into a lot of different things. And how we landed on pomegranate prebiotics was because we began tracking these secondary conversions of how microbes metabolize different food compounds and found a exceptionally strong signal for a certain class of bacteria that was only found in ellagic acid. elagitannins, and specifically in pomegranate polyphenols, punicalagin, and pomegranate type of electric acids. I don't want to get too technical, but this had a twofold effect. So one, after a course of antibiotics, we found that DS-01 and specifically the prebiotic that we use, which is whole fruit extract, actually starts to enrich back the gut microbiome and the bacteria which are able to degrade these plant compounds. So not only is your gut microbiome breaking this down, But your polyphenols are changing your gut microbiome. So it's a two way relationship and it's very powerful. These are metabolites that get directly into muscle that are responsible for regulating mitochondrial activity.

These are very interesting metabolites. So have you been able to measure people's blood levels of uric acid and A, for example, after taking seed, the probiotic?

Yeah.

And do you see increases in before.

And after in serum and, and urine?

You do.

That's amazing because, you know, this is something we've talked about on the podcast before. before your L-thyrosine is a postbiotic, something made by your bacteria that then is absorbed and it regulates everything from your mitochondrial function, mitophagy, the regeneration of the mitochondria, muscle strength, cardiovascular fitness, inflammation, and the list goes on.

And it's not something that most of.

Us actually can make because our gut bacteria are not that healthy and you need to write bacteria to actually make this particular postbiotic.

And yet what you're saying is that.

If use the polyphenols, particularly from pomegranate, which actually is where a lot of the urolithin A comes from. With the right bacteria, you can actually see increases in urolithin A in the blood, and then we'll have these systemic effects.

An interesting thing about this data is the effect was wiped away after a course of antibiotics, but over a course of a 12-week period of time slowly came back. Not only did we show that you're increasing these levels, but also that perhaps you're guiding the microbiome back after a course of antibiotics into a state which is more able to utilize these compounds that are not just found in DS01 but also from your diet.

Yeah, so it sounds like antibiotics are a big problem and, you know, we've all been on antibiotics. I don't think there's anybody almost on the planet that hasn't been on antibiotics at some point. Very rare. And they, do they have permanent effects on damaging the gut microbiome? Can you recover from it? What does the research show about this? And how is sort of DS01 potentially helpful in this? I know you're doing a study with Health Canada on using DS01 after antibiotic use and seeing its effect on the microbiome.

Yeah, absolutely. So antibiotics are the harshest, most acute threat that your microbiome will ever experience. However, the microbiome does recover, not its original composition, but to its original abundance. Studies vary sometimes between six months and sometimes up to two years afterwards, you see the biomass return. What's interesting is that you never really come back with the same microbiome. So every time you take it, you come back and you have a different microbiome. You have a different relationship between species, and sometimes the loss of rare species you had before that are now completely gone. And other times you have new organisms. And so every time you take a course of microbiome modulating drugs, antibiotics being the strongest, you play a little bit of roulette in which microbiome comes back, but the microbiome always does come back. If you're living in the world, it'll always come back to what it's able to in the environment that you're in. The study that you describe is finished. It was very exciting analyzing this data because the trial had four arms. One arm that came in, they didn't take antibiotics, they took a placebo. And then they took DS-01. They had another arm that came in and they took a placebo antibiotic and a placebo probiotic. It had another arm that took real antibiotics and DS01, and a fourth arm that took real antibiotics and a placebo probiotic. And so this really is a perfect trial design if you're trying to interrogate not just the effect that antibiotics have on the host, but the effect that probiotics can have after a course of antibiotics that are unique to antibiotics or a period of time when the microbiome is disrupted. We found some very interesting things. So first we found that the microbiome returned more or less after 12 weeks, to the same abundance of organisms that they had after antibiotics and everyone who took antibiotics, but that there were dramatic differences between the group that took antibiotics and DS01 and people that took antibiotics and had a placebo or spontaneous recovery.

And so, what was the difference?

For example, if you took DS01 alongside antibiotics and 12 weeks following, you had a greater rebound in what's called rare species. And this is species that had less than 1% abundance in the microbiome prior to taking a course of antibiotics. And so this was a very interesting microbiome mediated effect, right? So there was a kind of kick starting of that cross feeding reaction that happened concurrent to antibiotics that kind of allowed some of those low biomass organisms to come back after antibiotics instead of get out competed in the microbiome fighting to come back after the course of antibiotics. I think that was a very interesting finding. We also found an enrichment in butyrate-producing organisms. What's interesting is that although you didn't see an increase in butyrate, you had an increase in butyrate-producing organisms. And I don't want to get too nerdy or too technical here, but I think it's worth mentioning this because you talk about butyrate a lot. I think your audience has heard about butyrate a lot. People take butyrate sometimes that itself as a postbiotic. The reason why it's so powerful is because it's used up by your colonocytes. Your colonocytes actually use it as a primary source of energy. The hypothesis of this trial and what this data showed is that when the microbiome is challenged, when it's threatened, you're unlikely to see butyrate coming out in the stool when you're testing for it or enrichments in the blood because everything is being utilized. You have a bloom of these butyrate-producing organisms. But it's being used to help that microbiome recover back to its baseline state and to help those mucosal linings. And so this is a very interesting finding. I could go on and on. Probably the third and most important finding from this trial is that antibiotics themselves damage the gut barrier. There's this very invasive test, which is called lactulose mannitol test.

It's you drink.

I used to do that all the.

Time with my patients.

That's not nasty. No one likes doing it. They have to hang around for 10 hours and get tracked afterwards, see what passed through and what was absorbed in. But it's one of the purest tests, even though it's simple, it's one of the purest tests that tell you what molecules are going to make their way across the barrier and into circulation or be absorbed. And the results here were quite striking. So there was like greater than 90% damage across the board from antibiotics to the gut barrier. And so you saw acute, massive increases in epithelial barrier permeability, so gut barrier permeability after a course of antibiotics. What was striking about DS01 is that compared to placebo, we showed a very strong rescue effect and an almost complete rescue effect of that gut barrier with effects that persisted out weeks after the course of antibiotics. Again, it's very interesting. You think about your environment, you think about disruptions, you think about what could probiotics be good for. Here's data that says that in a disrupted environment, Probiotics and DS-01 in particular can have a rescue effect on those barrier disruptions. It can kind of return the gut barrier to a less permeable state. You stopped sort of having a leaky gut.

That's amazing.

So, let's first start.

What is irritable bowel syndrome? Syndrome is basically a thing that doctors don't know what causes. When you say syndrome, like polycystic ovarian syndrome or irritable bowel syndrome or chronic leak syndrome, it basically means it's a collection of symptoms. We have no idea what and we just say, well, it's a syndrome. The truth is we do know a lot about what causes IBS or irritable bowel syndrome. I treat this all the time. In fact, I've had it. It's no fun. And it can come in all kinds of sizes, shapes, and flavors, from bloating and distension, getting what I call food baby, it can cause you to have diarrhea or constipation or alternating constipation and diarrhea, cramping, discomfort, extension, it's just nasty. Maybe you have to run to the bathroom after you eat. It's just not a good scene. So what are the causes of this problem? And from traditional medicine, there's really no known cause. But in fact, from a functional medicine perspective, there are really clear causes. And we now understand the gut more than we ever have. In functional medicine, 30 years ago, we were talking about the gut and the microbiome. We didn't use that word back then, but we were talking about gut health and dysbiosis. And now that word dysbiosis, is really now in the traditional medical literature. Essentially it means imbalances in the ecosystem of the bugs that live in your gut. And there are a lot of things that cause imbalances. It can be from the environment, environmental toxins are a big cause, the use of a lot of drugs, antibiotics, big cause. A lot of people are born by C-section sometimes unnecessary, but they still affect the baby's microbiome because they don't go through the vaginal canal and colonized. There's often challenges with breastfeeding that women have. Formula feeding can often cause imbalances. The gut flora because they actually feed the wrong bugs. We see this in a number of different studies. There's often people who have intestinal infection, for example, like a parasite or traveler's diarrhea, and you can get irritable bowel after that because it destroys the microbiome. Obviously, it's the gut-busting drugs we take, antibiotics, the anti-inflammatories, the acid-blocking drugs, even the birth control pill can cause yeast overgrowth. steroid drugs, many, many drugs tend to cause gut imbalances and pick up different bugs like parasites. And also we can get heavy metals, heavy metals create a big injury to the gut. I had that myself. I had irritable bowel for almost 10 years because I had high levels of heavy metals and it took me a long time to get them out. So there's a lot of reasons. It can be bacterial overgrowth. That's a big one. We didn't even have a term for that when I was in medical school, but bacterial overgrowth is a really common phenomenon where the bacteria migrate up into the small bowel you're supposed to have in your large intestine, but there's not supposed to be a lot of bacteria in your small intestine. When you get that, it basically causes your body to ferment the food that you're eating, all the starches and the sugars that you eat, and you get this food baby bloating after you eat. It's a really common symptom, and we'll talk a little bit more about that in a minute. So there's all these different conditions that can happen that drive problems, and then often food sensitivities are a big factor. There's a lot of reasons for that. We get leaky gut, we get damage to our gut lining, and that creates this reactivity to foods that leak across the gut lining and your immune system reacts to them, creating inflammation and all these other symptoms. So it's not fun. Irritable bowel is not fun. It also has been linked to things like fibromyalgia and all kinds of other issues. So we're going to talk about what you can do about it, how to identify the big triggers. Now, a lot of times, food sensitivities are a big factor. it can be dairy, lactose intolerance is a big one, gluten which often cause a lot of gut issues, a lot of things that people eat, food additives can cause problems. Carrageenan, which is a thickener in gum can cause a lot of leaky gut issues and leads to more food sensitivities and more irritable bowel. Also sugar alcohols, I remember when someone gave me a chocolate bar, it was full of maltitol which is a sugar alcohol, has no sugar in it and zero calories but caused huge fermentation of problems in my gut when I was quite sick. So it's not good. So how do you kind of know what to eliminate, what foods are reactive? I created something called the 10 day detox diet, which gets rid of most of the common allergies, gluten, berries, sugar, processed foods, grains and beans for a short time. And often it gives the gut a rest, reboot, and then you can add things back and see how you do. We call this an elimination diet. And there's many forms of it, but it's the best test for food sensitivities. There's also lab testing. We can do lab testing for different antibodies against foods that can be helpful, but it's not definitive. The most common foods that I find people have, and ideally you should, I say, tend to detox, but it should be about three months to get off these foods. Gluten, dairy, eggs, corn, soy, peanuts, they're most common. Grains and beans, you see foods often are a problem, and then you can kind of introduce them one at a time. So let's talk about how gut issues, we call dysbiosis, leads to problems in the gut. Now, your small intestine is basically this absorptive surface. it's the size of a tennis court. If you laid it out flat, maybe two tennis courts. And it's one cell thick. It takes basically the food that you break down inside your stomach, through digestive enzymes and all kinds of other things. And the basic building blocks of amino acids, sugars, fatty acids, they get absorbed across the gut lining and they get absorbed through the cells. But sometimes when there's damage to the gut, from all the reasons I said, you get the separation of the cells. We call that leaky gut. And then food particles and bacterial particles leak in between those gaps. We call them tight junctions that kind of get loose. And then you get this reactivity to food because 60 to 70% of your immune system is in your gut.

Why?

Because that's where you put all this foreign material every day and your immune system is supposed to help you deal with foreign material. So that's really important to understand that you have this really delicate lining. and it can be disturbed, and that leads to this whole imbalance. And when that one cell layer is sort of disturbed and you get breakdown in the mucus layer, or the lining breaks down from too much stress, doing antibiotics, inflammatory drugs like aspirin, ibuprofen, steroids, maybe have crappy diet, processed food, usually affects it, sugar, starch, food additives, alcohol, then your immune system starts to get exposed to all these particles from food and bacteria, and that creates inflammation throughout the body that can cause weight gain, fluid retention, headaches. It's not just arylal bowel. It can cause widespread problems, arthritis, asthma, immunity, mood disorders, cognitive problems, hormonal disorders.

It's huge.

So your ecosystem in your gut plays an enormous role in your health. And when your gut bacteria are out of balance, you're out of balance and you don't have enough healthy bacteria, it makes you systemically sick. So one of the things that I find most helpful as I treat my patients is I always start with the gut. You know, we really help them get a healthy gut because when you do that, a lot of other problems go away. Autoimmunity, hormonal disorders, weight disorders. I mean, even in animal studies, when they have imbalances in the gut flora, you can see that these animals will gain weight. When you fix it up, they lose weight. And they've done even fecal transplants from non-diabetics to diabetics, and it improves their blood sugar simply by changing the gut flora. So it's super important. Now, there's another thing that's really important is how do you test for this? Now, I do a lot of stool testing. I do what we call organic acid testing, food sensitivity testing. So I do a lot of different things to look at what's going on in the gut. I check for gluten antibodies. I check for sometimes food sensitivities through Cyrex testing. I like that lab. We're looking at the IgA and IgG antibodies against food. So the different antibody your body makes against food particles, you can kind of see what's going on. It's not a true allergy, it's more of a sensitivity. And then I look at stool very carefully looking at digestive enzymes, the immune system in the gut, something called short chain fatty acids, which are important for keeping the gut healthy and the main food for the gut lining and regulates immunity. And, and they're produced by healthy bacteria. So when you don't have healthy bacteria, have very low short chain fatty acids like butyrate. And this is something we can measure on a stool test. We also look at genetic testing. We call it PCR testing for microbial RNA, we can tell what species of bugs are there or not there. I look for, for example, Akkermansia is a very important keystone species that makes sure you have a good mucus lining, regulates immunity. Your response to chemo drugs can help in regulating weight and so many different things. So it's a really important bug. I also do stool cultures so we can look at how much healthy bacteria, if there's weird bugs growing, if there's yeast growing. we do PCR testing and antigen testing for parasites. So we can get a really good comprehensive look at the stool, what's going on in there, and it's changed it obviously from day to day in what you're eating, but we can get a really good handle on the overall ecosystem. And then I can optimize treatment. It's not just looking at the bacteria, it's all the other factors. And then we look also at organic acid testing because in your urine we can find metabolites from the bugs that get excreted if they're bad bugs. so we can look at metabolites from yeast or various bacteria. They're not human metabolites. We can see if they're there in your urine. We know there's this overgrowth of bacteria. We also do breath testing because we want to know if you have bacterial overgrowth. We give you a drink of a fermentable sugar and you can see by collecting your breath whether you make too much hydrogen gas or methane. You know, we talk about cows, but humans also can produce methane and it's this fermentable simple byproduct that comes out of your body having too much starch and sugar and fermentable carbohydrates that get fermented. Just based like beer or wine or you have an apple cider container in your fridge and it blows up basically because the yeasts are fermenting all the sugars in the apple cider. So the same thing happens in your gut and you get this food baby thing. So we can tell, but the treatment's different for different bacterial byproducts like methane or hydrogen we'll talk about in a C. Bow is huge. It's a big cause of IBS. More research on this over the years. If you have bacterial overgrowth, you can have that with other things. You can have parasite issues. C. Bow is just small intestinal bacterial overgrowth, but you can also have C. Fo, which is small intestinal fungal overgrowth. And we're going to talk about that in a minute because it's so common. So most of your bacteria, like I said, should be lowered down, but they migrate up and we really have to.

Take care of them.

And there's a lot of ways to treat the bacterial overgrowth. And I'll talk about that in a minute. When you have yeast overgrowth, which is also common. You actually can tell people have that from a lot of other clues. They might eat a lot of sugar, they might have diabetes, they might be on antibiotics, steroids, they might have other fungal symptoms like dandruff, fungal nails or anal itching or skin rashes that are fungal. And you can tell, you know, from someone's history, the likelihood of a fungal overgrowth. But it's pretty common and it can cause constipation, more constipation, SIFO, or irritable bowel. And there's a lot of ways to treat it. I use a lot of herbs, oregano, thyme, and other really great herbs you can use for fungus. There's great probiotics like Saccharomyces that work against yeast. And sometimes you need to use an antifungal like Diflucan or Nystatin, Sporanox. If you have bacterial overgrowth, you might need other herbs as well. I use Biocidin, Candibactin-Ar, and BBR for Metagenics. But sometimes you need antibiotics. products like rifaximin, which is now approved for irritable bowel syndrome and also something called Neomycin if you have more methane. I use Transtel, which is a combination of herbs. It also works for methane SIBO. And methane SIBO tends to cause more constipation.

So you can tell kind of your.

Diarrhea, your bowel or constipation or a bowel like they have different, different phenomena going on. We do a combination of things that are not just the antibiotics fungal, but a whole gut repair program. It's not just about killing the bugs. How do you heal? And I see this a lot, you know, when people have various kinds of treatments for SIBO by conventional doctors, they'll just give me antibiotics and they won't do a whole gut repair program. In order to reboot your gut, you need to get clear about how to get rid of the bad stuff and put in the good stuff. So the get rid of the bad stuff is, and we call this the five bar program, or I call it the weeding, seeding, and feeding program. We weed out the bad stuff. So that's food sensitivities. if you have a parasite, we treat that. If you have SIFO or SIBO, we treat that. That's the first step. The second step is to replace the things that need to be replaced. You might need digestive enzymes, you might need hydrochloric acid, you might need some prebiotics to kind of fertilize the good bugs. You clearly want to get rid of all the things that you need to treat, whether it's the bacterial overgrowth, the yeast overgrowth, parasites. And then you want to kind of repopulate the gut health bacteria. That's the repopulate or reinoculate phase of the repair program. And that's where we give probiotics. And there's all kinds of different probiotics out there. We're learning so much about how to customize probiotics treatment. It's really different depending on what's going on for you and what your health issues are. And there's a lot of science now on how we can personalize probiotics. If you have SIBO and you take a lot of probiotics or prebiotics, it's going to make you sick. the bacteria in your small intestine are going to fight with bacteria you're putting in there and they're going to be fertilized by the prebiotics because they'll eat that stuff too. And so you'll end up getting worse. So the first thing is to get rid of the bad stuff. And so it's an elimination diet. It's killing all the bad bugs. It's giving more enzymes and probiotics. And then we do a gut repair program. We use a lot of compounds like polyphenols, which are really important for feeding the good bugs, green tea, pomegranate, cranberry, olive extract, prickly pear, all kinds of compounds that we use from phytochemicals that help feed the good bugs. We use zinc, fish oil, evening primrose oil, or GLA, glutamine, all sorts of compounds we use immunoglobulins like I use SPI protect for more than molecular, which is a really good dairy free immunoglobulin colostrum that helps rebuild the gut. So we use a whole series of things to help restore, repair, and renew the gut. so the key is if you really want to have a healthy gut, you kind of have to figure out what's going on. You might need help with a functional medicine doctor. You might need stool testing, but often just an elimination diet, some basic herbal therapies. Pre and probiotics are great. The way I approach this is I start with getting rid of the things that people need to stop, which is elimination diet, getting rid of processed foods, getting rid of sugary foods. Sometimes I recommend digestive enzymes, adding fermented foods, everything recommended dealing with your stress because the mind-body connection is huge. There's all these really simple ways that you can reboot your gut on your own. And I can't tell you how many people have just followed these guidelines and gotten better. That's not to say that if you really are struggling with bad overgrowth or parasites or yeast that you don't need some medical care. Sometimes you do, but most of the time you can fix your gut on your own. And I've created a product called Gut Food, which is a combination of prebiotics, probiotics, and polyphenols that I invented after I had severe gut issues, not only irritable bowel, but I ended up having inflammatory bowel disease after an antibiotic they took for a dental infection. So I had to really figure this out. And it's really simple. All you should do is just pay attention to what you're eating, eat a whole foods diet, eat pre and probiotic foods, and if you're struggling, make sure you get help because this is a really a fixable problem.

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