FIX YOUR GUT To Prevent Autoimmune Disease TODAY! | Mark Hyman & George Papanicolaou

You know, so many millions of people suffer from this.

And what we understand about the microbiome, what we understand that food is medicine, you can get better.

So from your experience, George, what are the top things you think about when you're seeing a patient with inflammatory bowel disease?

Well, the first thing I think of is disordered microbiome. I just think of, and then I think of all of the components that go into that from their diet, specifically their lack of foods that are prebiotic and probiotic. I think about the types of foods they eat that would be disruptive to the gut microbiome, like grains that have glyphosate sprayed on them if they're not eating organically. That's where I really begin to to dig down, dig deep, I look at stress. I will tell you that whenever one of my ulcerative colitis patients or Crohn's patients calls suddenly with an exacerbation, it's come on and they're in a panic and they want help, eight times out of 10, stress is triggering. And the role of stress in triggering this disease and driving it and causing exacerbations and making it even more difficult to get under control. So I think about lifestyle. I think about stress. I think about the role of exercise because exercise does play a role in controlling inflammatory bowel disease. I mean, stress and exercise have been studies that have shown controlling stress, getting your exercise, and altering your diet, those are three things that can make a big difference. So I think about those. when a person's coming to Manta, that lights up. What the causes are, there's obviously a genetic predisposition for people. And so we think about that. There's not a lot I can do to change the genetics at this point in medicine. I think about the, again, I go back to the immune system. We know that there's an immune triggering that goes on. And we know that the gut and the microbiomes very specifically, is the gateway to the immune system. That's why I think about it first because we need a healthy gut microbiome to have a healthy gut lining or that mucosal lining because that mucosal lining plays a very important role of providing very concise and precise communication between the gut bacteria and the immune system. 'Cause the gut bacteria and the immune system work very closely together to make sure that we are protected from outside danger, things that aren't us. And when that gut microbiome, those bacteria aren't healthy, then that mucosal lining breaks down, and now toxins and bacteria and viruses, heavy metals can get back into our system and recirculate. increasing our toxic load, further damaging our immune system, further creating inflammation to trigger or maintain that inflammatory process that we call ulcerative colitis and Crohn's disease.

Yeah, what's great now is we're learning so much about the microbiome and so much about how to work with it and how to optimize it and what harms it. George is also the diet is such a key thing for most people. and it's not only eating an anti-inflammatory diet, it's not only getting rid of the food additives, the emulsifiers, and the things like the carrageenan and other things that can cause damage to the gut lining, but it's also thinking about how do we reduce all the potential inflammatory factors in the diet and all the potential food allergens. And, there's been some interesting research done on what we call an autoimmune paleo diet that's been shown to be effective for Crohn's. in colitis in trials. And I think it's really been overlooked for the most part. But can you talk about what is an autoimmune paleo diet and how does it work for Crohn's and colitis?

Yeah. So, as I said earlier, the microbiome is the gateway to the immune system. And we know that there is a strong immune component to inflammatory bowel disease. The autoimmune paleo diet, I want to put my glasses on so I can see you better. So the autoimmune paleo diet basically is going to eliminate foods from your diet that can trigger your immune system to have that autoimmune response and to create that inflammatory response. It's going to allow the gut lining to heal. There are foods that are thought to.

Really-- what do they take out? What is an autoimmune paleo diet? What do they take out of that?

They're going to take out grains. legumes, nuts, seeds, nightshades, eggs, and dairy, all of these have inflammatory components to them. Dr. And so, then, you know, you, yeah, so that's the main things.

So, like grains and beans and nuts and seeds and eggs are supposed to be healthy.

So, right?

Dr. How is that? Dr. They are, they have inflammatory components to them. Once you know, your system begins to break down, then those foods can tend to have trigger the immune system to have an increased autoimmune response. Because what happens with some of those foods is that you develop the mucosa breaks down so it can't do its job. Number one, it can't break foods down, so you're not going to get the nutrients that you need. Number two, that mucosa now, this very finely designed gate system is broken. and these foods, when they're not broken down into the smallest peptides possible, can actually, they don't have to be because the gates are broken. So now you have these larger peptide forms, and these particular foods, their proteins, are inflammatory to the immune system when they're larger and the immune system can't recognize them. So the immune system begins to create the autoimmune response and the inflammatory response. so that's why these particular foods are taken out. And it includes alcohol, coffee, it includes processed oils, corn oil, canola, cotton seed, you know, you want to not have those oils in your diet as well.

Absolutely. And so you're getting rid of all that stuff. And what are the kind of results are seeing with those patients?

Well, with an AIP diet, we see We see very good results. Because a lot of folks, when they've come to us, they've never been told that you can eat a certain way to improve your symptoms. When we take these foods away for six to eight to 12 weeks, it gives the intestine and the immune system opportunity to to rest. Now you can get healing of the gut because you are still eating very nutritious foods that are healing to the gut. Once the symptoms begin to be vanquished, they're able to tolerate more foods, we can get more fiber in, we can get more probiotics in, and then the healing process really begins. By 12 weeks, we're seeing people with all symptoms are gone and they feel great. And that's using AIP with probiotics.

That's incredible. I mean, really, when you think about the fact that this is such a debilitating disease, that it's such a difficult challenge for patients, that the drugs are so potentially toxic and harmful, that, you know, so many millions of people suffer from this. And that what you're saying, George, is that in functional medicine, we have a map to figure out why. Yeah. We have a approach to improve the microbiome, to treat them with an anti-inflammatory diet and to reset the gut microbiome through a whole host of interventions that we call the 5R program in functional medicine. We've talked about that on the podcast before. And we also, you know, tend to look for other things that people don't look for, like heavy metals or infections or other issues.

Yeah.

And it's amazing. what you'll find and what you see. And it's so gratifying. I mean, of all the conditions, I love it when I get a patient with Crohn's or oh, yeah, because it's such a slam dunk.

And for me, I had one of.

Those cases that just was not getting better. And so I always get the cases.

You know, the worst of whatever it is.

And then I have to figure it out, and I figured it out, and I think, you know, there's other treatments.

That can be helpful.

And I used ozone, I used exosomes. These are a lot of different things, but. It's quite amazing when you see the potential for this.

Yeah. I want people to know that there are—look, you're really sick, you're not feeling well, and you're having bloody mucous stools, and you're having them 11 times a day, and you're having pain and you can't eat. You're desperate. Then you're going to be told, well, guess what? We're going to put you—we're going to eliminate all the foods that you like. Well, you know what? Sometimes, unfortunately, We don't even—you can't even start an AIP diet. Because people, when they come, can be so debilitated that they can't tolerate food. To really give their gut a rest, I'll use something called an elemental diet. An elemental diet is basically medical food that has all the nutrients that you need but doesn't require your body, your broken mucosa, to break down the proteins and the complex carbohydrates. We're able to use the Elemental Diet to really rest and really get all the symptoms calmed down, then move on to AIP, then add in our probiotics. Then we have other things that we can do for long-term maintenance of a healthy state. Some things that can boost the immune system. modulate the immune system, immune response, and I'll use CBD with THC blends that again can have a modulatory effect on the immune system, decrease inflammation in the gut, increase appetite. And so there are a lot of things that we can do in functional medicine, just as you just pointed out. And those are some of them in a little bit more detail. Wow, thanks, George.

Well, listen, we're going to get right into it. So inflammatory bowel disease, how common is it? what is it, what symptoms do people get, and tell us about what we know about the disease in terms of a traditional approach from traditional conventional medicine. What's the approach to this? Because it just seems like a vexing problem and we just seem to have made some advances, but still it's not great.

Yeah, so it's very common. There's about 3 million people have it per year in the United States of America. That is actually up from 2 million in 2000. So there's a very steep increase over the last several decades. And the projections are that it's going to increase at an even more rapid rate over the next 20 years. So ulcerative colitis, Crohn's disease, which both are the two major inflammatory bowel diseases, are frequent and common and are very, very disruptive to the people that have it. It can really just completely upend their lives. Depending on how quickly you want to get into this, I can get right into it. I'm just thinking of all my patients and their suffering. I can tell you that when it's uncontrolled, there is a lot of pain, there's a lot of diarrhea, there's an inability to eat, there's fatigue and weakness that keeps people from being able to do their jobs. Weight loss. all of those symptoms, malnutrition can be included in there. So, there's a lot of people that have it. It's a growing problem, and when you have it, it's very disruptive. And even when you are well, you have to work hard at staying well. Yeah, it's a huge problem. And, you know, it's basically an autoimmune.

Disease of the gut. What's amazing to me is in traditional gastroenterology, I've talked to gastroenterologists and they're like, oh, you know, what you eat doesn't really impact it. I'm like, wait a minute, you're putting pounds of some foreign substance in your mouth every day that's going through your gut. How could that not affect it? It's just so striking to me that there's just this complete, almost ignoring of the role of nutrition and food in what's going on with gut disorders. That's just kind of a meta comment. To make it obvious like duh to me.

Yeah, but to make it to retort with another meta comment, I would say that In our food, yes, but in that food are toxins. And in our environment are toxins. And we have medications and we have endocrine disrupting hormones, all of which end up in our gut microbiome and are very disruptive. And if a person has a genetic predisposition to ulcerative colitis or Crohn's inflammatory bowel disease in general, then they're going to be at high risk for triggering that gene and developing that disease they have a predisposition for. It's our diet, it's our environment, it's the stress. All of those can trigger your genetic predisposition.

That's absolutely right.

Because you have to ask yourself the question, why have we had such a rapid increase over the last several years?

Yeah.

What's going on?

And this is your area that you are the leading edge of the medical voice in understanding agriculture and food production in our country and how it is toxic and why it's toxic. We don't have healthy soil and that's where it begins because if we don't have healthy soil, we're not going to get the nutrients in our gut soil. to grow good bacteria and have a healthy microbiome so that our intestines can stay healthy and do their job for us. Yeah, it's such a big deal.

And, you know, from a conventional perspective, the treatments are really to shut down your immune system, right? Oh, yeah. Prednisone, steroids, chemo drugs, TNF alpha blockers, things that, you know, increase your risk of cancer and infection. They're pretty extreme drugs and they can be very helpful and they can be life saving and they can work for people. But the question is, is there an alternative? Yeah, well. And do, you know, do we have to deal with this the same old way we've been doing with it? And then, of course, for a lot of patients who have it, sometimes they need surgery. They do total colectomies for ulcerative colitis, so they remove your entire colon or resect whole sections of your bowel with Crohn's disease, which doesn't really even cure the problem.

It's just a rough, rough disease. It is rough. And I think you and I can bring people some really good news today. that using functional medicine and what we understand about the gut microbiome, what we understand that food is medicine, you can get better and stay better without having to use the kind of drugs that you just mentioned that can lead to cancers down the road. People on immunosuppressive drugs, you know, followed for 20 years, or, you know, they're already at very high risk. They're already at increased risk with the inflammatory bowel disease for colon cancer. And then if you put them on an immune suppressive drug and follow them for 20 years, they have an increased rate of skin cancers by about 40%. And so, and during that period of time, they have increased rates of infection, they have side effects to the medications, they have to come on and off them, they have to try new medications, and by and large, you know, they're moderately effective and sometimes not effective at all for some people.

For sure.

And I think that people suffer a lot from this and it can manage the disease, but it often doesn't go away or it's not curable. But from a functional medicine perspective, it can be really curable. And I can tell you so many patients that I've had, I mean, I just actually how I got the job and probably how I got the job at at Cleveland Clinic was because I met someone to the CEO whose niece had severe colitis, tried all the medications, wasn't working, was about to have her total entire colon removed at 32 years old. And I said, look, just have her come to me. No promises, but no, it's worth trying before she rips out her entire colon, which is irreversible.

Right.

And I think she was skeptical. She was from New Orleans and probably wasn't the healthiest, you know, lifestyle down there. And she agreed to do what I told her to do, but she was quite skeptical. But I changed her diet. I reset her gut microbiome, you know, simple things, simple things. And six weeks I talked to her. She said, I'm perfect. I'm fine. I'm on no medication. And I'm like, what? Literally six weeks and they were gonna take her colon out. and she's symptom free and off her medication. And I can tell you story after story like that. Another young kid was 25 years old. Same thing about take his colon out. Just some simple dietary lifestyle changes and, and getting the gut microbiome straight and resetting the gut with the functional medicine for our five hour program is so key.

So I think, well, it's, it's, we had, we had talked earlier as we were preparing for this, and one of the, one of the, I think one of the first things that happened, and you can correct if I'm wrong, but You met with Dr. Ruggerio, who's a GI doc, including clinic, and you guys set up a collaborative to work with functional medicine and traditional and conventional forms to treat ulcerative colitis, inflammatory bowel diseases. And, that sounds like a phenomenal partnership.

Absolutely.

It really is. And, I think there's a real openness to understanding there's really room for this, including with everything. It's not either or. How do we create the best conditions for a patient to get to health? And, I think in terms of causes, let's sort of dive into that because from a functional medicine perspective, we really look at root causes. And, today I was going through my medical research that I do every day and just sort of looking at what's new and was sort of shocked to see this. Well, not really shocked, actually kind of expected it, but I was shocked to see it sort of published so prominently in a medical journal, really, really discussing the way in which food sensitivities, I mean, sorry, food additives and ultra processed food will drive changes in, in people's gut. So when you look at this data, it was quite interesting. They looked at mice and people, and they basically show that high sugar processed food diet affects the gut in a harmful way. We also know that there's a lot of emulsifiers and additives in food like they're thickeners, even things like microbial transglutaminase, which is a like a gluten product that's put on purpose in food to make it stick together because gluten makes it glue makes it stick together. And so we have to sort of think about when we take care of these patients what their causes are. And I've seen all sorts of cases of Crohn's and colitis. And I just share another story of a guy who I saw years ago who had severe colitis was really losing weight, struggling. I tried all the normal functional medicine stuff, reset his gut microbiome, the 5R elimination diet, you know, tried everything, the right supplements, and he just wasn't getting better. And so I went back to the principles, first principles that I learned from Sid Baker, which is what could be bugging this person that needs to be gotten rid of? Is there something else that I'm missing? And what am I missing? Is there something I'm missing?

Yeah.

So I went back to the drawing board as my medical detective hat on and and found out this guy had really high levels of mercury. And it wasn't until I chelate his mercury that he was able to correct his colitis and is now symptom free. I personally had a different cause. I was somebody who mostly had a healthy gut most of my life and then I developed mercury poisoning and that.

Messed up my gut.

I didn't get colitis, but I had really bad irritable bowel and bacterial overgrowth and all sorts of issues that I cured. Then a few years ago, about five years ago, I got a confluence of events where I ended up having to take an antibiotic for a bad tooth and a root canal, and it was clindamycin, and this antibiotic is known to cause C. difficile, which is a really common intestinal infection that causes death in about 30,000 people a year. And all of a sudden, I started getting not just diarrhea and this and that from it, I started getting really severe pain, nausea, going to the bathroom 20 times a day, bloody bowel movements. It was just, it was miserable. I literally was in bed five months running back and forth to the bathroom. And turned out I had developed colitis from the C. Difficile, and then it continued even after we cured the infection. The colitis continued. And so I had to really go back to the drawing board to think about what do I do? Because I also had mold exposures and I had all these imbalances, I had low acromania. So I learned a lot about on a personal level, which I really didn't to learn that way, but I learned about what the symptoms are, what it does, and how to actually start to think about fixing it differently.

Yeah.

And for me, I did a number of things. I used a cocktail of I call gut food, which is a cocktail of components that have, I think, not really been put together too often, including prebiotics, probiotics, polyphenols and immunoglobulins and things that really help the body to reset the gut. And I also dealt with the mold that I had in my house, and I also used ozone to help boost my immune system and kill infections. And it was really amazing. Within a very short time, I was able to really recover. And I think a lot of us sort of struggle without really knowing what to do. And even sometimes when you do an elimination diet, if you have colitis, you don't necessarily always get cured because there may be something else going on. Maybe like what I had, maybe there was C. Diff or maybe there was mercury or maybe there was something else going on. But you can really help these patients so much. Crohn's is often a little more challenging, but we do a lot of different approaches. So traditional medicine, it's pretty cut and dried. So what are the kind of things we find that work the best? And talk about from a dietary approach and then sort of drill down into the other aspects of our treatment for colitis and Crohn's disease. Right.

So the, you know, neck and neck, it's diet and gut microbiome, right? So it's really neck and neck. and I will say with the gut microbiome, it's very intriguing because there's more and more research being done into the differences between a healthy gut microbiome and the gut microbiome of a person that has inflammatory bowel disease. And there are significant differences. And in a person that has inflammatory bowel disease, one of the key Bacteria, as you mentioned earlier, is Akkermansia. Akkermansia plays a role in keeping the mucosa, the gut lining, the goblet cells really healthy. It breaks down the mucin, and then when it breaks that down, it turns it into short-chain fatty acids. We know that short-chain fatty acids are the, that's the honey. of the colonocyte. It just loves its short chain fatty acids and that keeps it really healthy. People who have inflammatory bowel disease tend to have really low levels of Akkermansia and it's not uncommon for me to find that they're not even detected when I do the complete diagnostic stool analysis on patients. So replacing Akkermansia has been shown to have an important role in helping the gut mucosa heal. There is a study that I had come across in preparing for this. It was in the European Journal of Inflammation 2020. Basically, in this study, they took bifidobacterium. Another strain of bacteria that is found to be really low in patients with inflammatory bowel disease. And they took a specific strain, Bifidobacterium lactis, and they combined it with xylose glucan, which is a non-digestible fiber source. So they had a prebiotic probiotic together in a patient with ulcerative colitis. and they followed all of the patients in the study and control groups, and they found that there was at six weeks, the study group had significantly more healing and resolution of their symptom, more healing of the gut mucosa and healing and resolution of their symptoms. And this is just, they had no other therapy. This is just a prebiotic and a probiotic. that they use. Using probiotics to control and to resolve an exacerbation can be really critical. I think we're learning more and more about how they work. There are other probiotics or other bacterial species that are missing or in low concentration in patients with inflammatory bowel disease including lactobacillus GG, saccharomyces boulardi, and when you replace these you find huge benefits. So I use probiotics pretty quickly in a patient. I also will use, there's a probiotic called VSL number three. A lot of people know about that because it's frequently used and it's really powerful. It has all the screens of lacto bacillus, and bifidobacterium that are low and are also very helpful in healing that gut lining and gut mucosa. And just by using that, I've been able to help people start to feel better and see their symptoms resolve. So as you can tell, the gut microbiome using probiotics are really a big part of how I'll treat my patients. But that has to be balanced about what they can tolerate and where they are in their disease because the diet then becomes really important. Sometimes I can't give probiotics right away. Sometimes I've got to get this person eating. I've got to get them feeling better before they can actually tolerate the addition of the probiotics.

What are the kinds of diagnostics you'd see us using with these patients to figure out what's going on with them?

Well, traditionally, you're, you know, first you're going to get their symptoms. I always like to go back to the basics. You know, we've got to remember that we're doctors are cognitive beings. We are medical detectives. We like to think. So I think you need to make sure that you're listening to the patient's story, hearing all of the symptoms, doing a really good examination, and making sure you do that part. because that's where you find those predispositions, you find those triggers, and you find those mediators that are so important because that begins to, those are the categories you think in to solve the mystery. Okay, so once we've, you know, I've done that piece and I have a really good idea of what the predispositions are, I have a really good idea of what the potential triggers are, 'Cause those triggers can give me an idea of how I'm going to help them get better and control it down the road. And some of the mediators and perpetuators, you know, that could be, you know, stress or that could be their diet. Once I have those pieces, then I say, okay, you know what? I'm pretty sure you have ulcerative colitis. You know, how do we, how do we know for sure? We can check inflammatory markers like something called Calprotectin, which will be very elevated in people with inflammatory bowel disease. And then we can also visualize, and it's the gold standard, is to visualize with the colonoscopy, the intestines. And you can, you'll probably do both an upper and lower. And you'll see that with Crohn's disease, it can involve the entire intestinal tract, whereas with colitis, it typically just involves the very end or the distal part of the large intestine, the rectosigmoid and the first third of the, or the last third of the colon. And that will be, that will visualize it through colonoscopy. So those are, that's the conventional way. And then, once they land in my lap after, you know, being frustrated by just not getting better or finding that their diets are really restrictive and they're constantly having symptoms and they're not finding any answers in the places they're looking in the conventional medical world. Then I immediately go into action and I'll look at the complete diagnostic stool analysis where we will get a full complete picture of your digestive processes. Are you making enough gastric acid, pancreatic acids? Do you have markers of inflammation? Is your detox system in your gut working correctly? is your immune system responding, over responding, under responding, and it will also tell us very specifically the diversity and abundance of your gut microbiome. And so it's one of the, it is the first test that I'll get, but I'll also look for other things. And we should have mentioned this earlier, but I'll look for SIBO, which is small intestinal bacterial overgrowth. I will look for food sensitivities, particularly to gluten. I'll look for leaky gut, and I'll also look for those cross-reactive foods, foods that act like gluten, that can create inflammation if you're sensitive to gluten, and then be a trigger for your ulcerative colitis. Those are some of the tests. I'll do an ion profile or a micronutrient, it's a functional evaluation of all the most important biologic processes that your body does. And it allows us to determine which systems are or aren't working. And if they're not, what nutrients are you missing? Do you have, particularly when it comes to the mitochondria, do you have compounds or toxins that might be impairing those functions like with you? you had mercury elevations that probably were impairing your mitochondria, probably impairing your immune system. And on top of the other conditions you had may have tipped you over and made you more susceptible to the adverse outcome with a antibiotic. So we're looking at all those things and those are the tests that I look at. And I may do some, Well, yeah, I usually will stop there in my first tier. I usually get most of all the information I need with those tests.

Yeah, it's true.

I mean, I do look at food.

Sensitivities, look at the gut, look at heavy metals, and those can often be so helpful in figuring out what's really going on with people. And then you end up being able to sort of customize their treatment based on what you find. There are some dietary approaches, but when you get to it, you don't deal with the root causes and figure out what you're doing initially, it's a problem. That's really what we do at the Ultra Wellness Center. We map out what's going on with people at a much deeper level. I mean, look at things that most traditional physicians just don't look at. Like, who's measuring acrylamide levels? Well, we do because we want to know what this particular bacteria does. We want to know what your nutritional status is. We want to know whether your gluten's an issue. We want to know what's going on with your gut. Is it leaky? I mean, we do all these things.

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There's not a patient that comes to me that even if they're coming for one thing, that we don't end up talking about their gut. It seems like gut issues are epidemic.

Huge, huge, huge.

And ulcerative colitis and Crohn's disease, I think, are at the apex of the severity of what can happen when you have a poor diet, you have a disordered microbiome, and now you have an immune barrier that's broken, and now your immune system's under siege, and it can't respond appropriately.

Yeah. Well, I'm telling you, George, this is one of the areas in functional medicine that I've found over the last 30 years has been such a gratifying area because people really suffer. The traditional approaches are kind of limited and the potential to heal the gut through restoring the microbiome, changing diet and some simple measures is just huge. It's huge. And so, I'm excited about having this podcast with you because I think when we see these interventions in functional medicine working out the way they do, it's just such a life-affirming thing for me as a physician. you know that I'm helping someone. And, I've been there. Like, I've had all this. I had 20 bloody painful bell bottoms a day. I was nauseous in pain for five months. I was just, it was in bed. Like, all I could do is go bed, bath, bed, bath. It was like, it was terrible. And, and now I think, you know, we have such a clear roadmap to how to fix this. And, there's some other weird things that people are doing, like using worm therapy and other things. I'm not, I'm not, I don't use that that often, but it can be helpful. So, there's a lot of tricks in.

The functional medicine toolkit.

And George, you've been really great helping us understand inflammatory bowel disease.

Tell us first, what is leaky gut?

Yeah, so many people are saying the word leaky gut, leaky gut, but officially, 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 why I'm still drawing it each time. I'm gonna go to Google images. That's very smart. So we know there's this one cell layer, right? There's that one cell layer of the endothelium that divides the inside of the intestine, right? So where the food is and all.

Sorts of other things that your GI tract is is a tube that's literally.

Outside of your body.

I mean, it's a protected tube that you put food in, all that stuff goes in, it comes out the other side, and it's literally 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 and what shouldn't. What's been properly digested food, you know, has this Has this protein been broken down enough yet? Should this come in? 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 is supposed to work. That's great, yeah. 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, it may trigger, 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 you 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, you know, 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 laid 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. It's like. And. 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 soreness. 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 also.

Yeah, so it's really 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? And it's so much because of our crummy food supply.

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

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

And I mean- Dr. Like glyphosate from 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, right. And 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. 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 is 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. 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? I mean it's so many people are coming in with 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, it's the gut and 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, everybody's 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.

Yes.

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 gut. Rheumatoid arthritis or autism or whatever, you got to start with the gut.

Yes.

And traditional medicine Leaky gut is not a thing. You go to the doctor, if you have arthritis, they're like, how's your gut? 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 there'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, 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 he was telling me 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 it 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 and he says, I don't know what happened, but my blood sugars went to 90. So we absorbed all the toxic crap in his gut that was causing inflammation, that was causing his blood sugar imbalance. And 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, right. When we're saying why is that, 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 think I'd like to sort of get into it because, you know, 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 lenses, 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 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 a 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've never seen this patient as your patient, but I've 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 and 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 traditional GI doctor and they told him, you have irritable bowel, but he wasn't getting any better, right? And he was just really, because he was having so much stomach pain, he had lost some weight. So he wasn't, you know, he was 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, right? And so for him, well, for everyone, the timeline is so important, right? That's what we learn in functional medicine is the gathering that information, learning about that individual patient's story, seeing the patterns.

So, we start with the 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? 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, this patient came in and this little boy was coming back and like the toddler was coming back over and over to the ER with ear infections and just so inflamed. And I said, how was he like, did you breastfeed?

Yeah.

So when did he start getting 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.

Yeah.

The kid was fine. 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's not, you know, that wasn't too much. But, you know, 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 some of the imbalances in the microbiome, right?

When you screw up the gut with antibiotics or a C-section or lack of breastfeeding, then you get often more acne. We treat acne on 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 sort of stomach bug, so some probably viral stomach infection. And then since that time, he started to have all of these digestive issues and was losing weight.

Which is a common story. People are so common. this sort of smoldering a bunch of insults over the course of their life. You know, maybe they were a C-section, they had antibiotics as a kid, they took acne antibiotics, they had, you know, 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 and asthma that it plays. I mean, we're actually doing this at Cleveland 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 him off of gluten and dairy while we were waiting for tests to come back. Sometimes we will do some tests that look at, of course, we'll test for celiac disease or-- 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. You can have, they call it 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. 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.

Absolutely, and even regardless of, 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, 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.

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. Most of the time we can.

Yeah, and so it's part of the approach of functional medicine. We start them on the elimination diet. So eliminating all the inflammatory foods, gluten, dairy, processed foods, all that stuff. And then you remove, right?

That's the remove.

Right.

Five R is remove, replace, reinoculate, repair, rebalance.

Yep.

And we'll go into each of those because they're really important. But the next step is also there's other things we may need to remove. There's tests we need to do. So what kind of tests would you look at as a functional medicine doctor that you wouldn't see at a the traditional doctor's office that give us a roadmap of how to treat these patients.

Right, so we did a stool test that looked at his microbiome. And what we noticed is that there was an overgrowth of unhealthy bacteria and unhealthy yeast. So he had this, you know, probably because of years of antibiotics, he developed this dysbiosis, this imbalance in the bacteria and yeast. And so there was an overgrowth of the unhealthy things.

It's like weeds, having a lot of weeds in your garden.

Yeah, right. Right, it's not always like one of those, you think of a stomach infection and you're getting really, really sick, you're throwing up or having diarrhea. This is this, it's an imbalance and it's called dysbiosis, but that imbalance causes a lot of symptoms in people. When you have the wrong bacteria and the wrong yeast levels, you can get a lot of bloating after you eat, you can get a lot of fatigue, after you eat, you can get those symptoms of constipation and diarrhea and that causes this inflammation in the digestive system so all of your digestive enzymes don't work well. So you're not breaking down your food well, you're not absorbing your nutrients well and it becomes this vicious cycle that people are dealing with and we see all the time.

Yeah, it's so powerful. So, you know, when I see this patient, I'm like, okay, you don't have to do all the tests, but sometimes you get stuck suck. You look at various tests that look at antibodies against things that are in the gut that determine a leaky gut. We call it Cyrex 2 testing, which is a test you can get to.

Determine if you have a leaky gut. You can test to see if there's leaky gut. I love that test too, because it's a great way for us to follow up and see how much we're seeing improvement. Are we doing enough? Are we seeing improvement in their leaky gut or increased intestinal permeability.

And then we look at poop testing. We do thousands and thousands of these tests and it's so helpful and it doesn't just look at the microbiome, it actually looks at the function of the gut. Whether there's malabsorption, whether you had no digestive enzymes, whether there's inflammation, whether there's overactive antibodies in there, whether you have imbalances in what we call the short-chain fats, which are the food for the colon. that are produced by bacteria eating the right kinds of fiber. And if they're low, it means there's an imbalance. Then we look at the microbiome, we look at what grows, we look at parasites, and then we target and micro-target the things that are out of balance for that person. And it's different for everybody. Then we might look at food sensitivity testing. We might look at, and even things like heavy metals or other things which can also cause it. I had a patient with ulcerative colitis once, and I did everything right. I did the whole 5R wasn't working. But I forgot the first part of the R, which is remove. And I thought, well, maybe heavy metals can cause autoimmunity. Maybe it's a problem. And so I tested him and he was wasted away and it was terrible. He actually had high levels of mercury. We treated his mercury and his colitis went away. Which is phenomenal. So I think it's so powerful. This case is so important because it really describes how a patient goes to a traditional doctor, diagnosed with a disease, Irritable Bowel Syndrome. By the way, anytime you hear syndrome, it means doctors know what the heck is going on. It's just a collection of symptoms that we agree we're going to put in this bucket and if you have those symptoms, you have this disease. But it's not really a disease. And so that's what functional medicine is. It sort of looks upstream to figure out what the root causes are and.

Personalize the treatment for everybody. And there's common things that we do like the 5R, but it may be different R's for each patient. Right. Right, so for him, we removed the inflammatory foods and we removed the bacteria and yeast. I actually treated him with an antibiotic, a non-absorbed antibiotic, and an antifungal. So I treated him with a prescription medication, a weed killer. So that was the remove, right? And then the replace, because he was underweight and because of that inflammation in his digestive system, I gave him some digestive enzymes. for a short period of time just to help him, to help it so the food wasn't as inflammatory for him and to help him absorb more nutrients. And then we worked on re-inoculating, right? So after we gave him some good probiotics.

Put in the healthy bacteria.

Put in the healthy bacteria. Some good prebiotics. Right, so we know that- what are prebiotics? Prebiotics are the things that help feed the good bacteria. so they're the food for the probiotics.

Which is usually what?

Like? Like fibers. Fibers are amazing prebiotics. We know a lot of phytonutrients are prebiotics. So this, I think, is really exciting research when we're looking at our phytonutrients. What are phytonutrients? Right, so I know, it's amazing, right? So our food has minerals in it, it has vitamins, but it also has these things called phytonutrients, which are these components in our plant foods that have this amazing health benefits for us. So that can include things like ellagic acid that we see in pomegranate that can feed some of the good bacteria, that Akkermansia that we know can lower inflammation.

We know that... Just to back up on that Akkermansia thing. So when we look at the poop, we can tell if there's good levels of different bugs. One of them we look at is Akkermansia. and it turns out that that is so important for protecting your gut. It helps you keep your biofilm or that little coating over the gut so you don't have a leaky gut. And it's involved in so many autoimmune diseases and response to cancer therapy and metabolic issues and weight. And it's such an overlooked thing. You can't take a probiotic of it, at least not yet.

But you can feed it, the good guys. We can feed it. We can feed it with all these amazing phytonutrients like what's in pomegranate, the ellagic acid. And also we know that sulforaphane from our cruciferous vegetables feeds the good bacteria.

So broccoli, collards, kale, but not juicing it.

Right, Brussels sprouts, all those good ones. We know that green tea, that has good phytonutrients in it that's good for the digestive system. So we always say to people, get something from every color of the rainbow every day. you know, you'll get some plant foods from every color of the rainbow every day. Get some good red foods like the pomegranate or cranberry. Get something orange and yellow and green, blue, purple, white, tan. You know, all those good healthy plant foods that we, you know, like our vegetables, our fruits, our spices, our teas, our coffees really actually are impacting our microbiome, which is fascinating.

Dr.

It's so great. And, you know, this is a great anecdote from a colleague of mine, Dr. Lee, who was on our podcast talking about eat to beat disease. His mother had stage four uterine cancer. And being the smart doc he is, he understood from the research that if you have low akkermansia, patients don't respond to the immunotherapy, what they call the checkpoint Inhibitors, which is this new form of cancer therapy that helps activate your immune system. So if your gut isn't healthy, you can't actually get the cancer cells to die with immunotherapy. So basically you die unless you have good bacteria in your gut. So his mother had stage four uterine cancer and was gonna die and wasn't responding and he gave her pomegranate, cranberry, green tea, all these phytochemicals, got her acrymancia levels up and she was cured of her stage four cancer within a month.

That's a phenomenal story.

It's an incredible story and I think that just shows the power of these plant foods. Of the plant foods and of getting focused on the gut.

Yes.

Hey YouTube, if you like this video, you're gonna love the next one. Click on it to check it out today. And our diet also plays a huge role in the growth of good or bad bacteria. So you can feed it certain things and it makes it worse and other things and it makes it better.

So talk about that. Yeah, so I always tell patients that.

When you're eating food.