How To Address Gut Issues And Get Back To Optimal Health

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

The number one reason for doctor visits is gut problems. Irritable bowel, we think, oh, it's the irritable bowel, it's not a serious disease, but it accounts for 10% of the.

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Hi, this is Lauren Fein, one of the producers of the Doctor's Pharmacy podcast. Gut health is one of the most important factors in overall health, yet the most common complaint during doctors' visits is gut issues. Sadly, most conventional treatments don't work because they don't get to the root cause of the problem. In today's episode, Dr. Hyman talks to Drew Proett and Dr. Elizabeth Boham on why gut problems need to be investigated and how functional medicine doctors approach gut health. They discuss dysbiosis, bloating, how poor digestion can lead to malnutrition, Dr. Hyman's own gut health story, and so much more. Let's jump in.

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

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

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

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

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

And that is a microbiome destroying chemical, for example, heavy metals or nothing. Let's just pause on glyphosate because I think some people hear that and they're like, shit, this guy watches everything that he eats and is like paying attention and is like the guy that's teaching people. So, it was a little bit of like, I just didn't want to leave it hanging there. Is it like, kind of like we're all doomed or is it like, how.

Are you mitigating that? No. Like, how are you mitigating that? Well, now I'm a little more careful when I go out and I'm a little more cautious about what I eat and I'm just more smart about it. But, you know, unless you're, you know, buying all the food yourself and cooking.

All yourself, you always don't know what's in stuff. And it's also a reminder that all these other things that you do, regularly, you know, working out, sauna, et cetera, taking the right supplements, those things are helpful to get rid of that buildup in your body. Yeah.

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

Okay, let's go into stress next. What do you want to talk about when it comes to stress and what do you want people to know when it comes to how stress can significantly destroy our gut health?

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

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

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

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And now let's get back to this week's episode of the Doctor's Pharmacy.

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

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

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

From Yeah, I mean the top three things that are likely to cause problems for the gut are gluten, dairy, and refined starches, like 1-2-3, those are big. If you have gut issues, get rid of those and see what happens. If you wanna go a step a little further, try getting off fermentable starches, greens and beans are a huge issue, and certain vegetables can be problematic. There was a very amazing book called Breaking the Vicious Cycle by Elaine Gottschall years ago written that talked about how to treat ulcerative colitis by using what she called a specific carbohydrate diet. So it took out all sugars that needed to be digested. So you didn't get this fermentation and this bloating and distension and inflammation. So those are the things you want to get rid of. The things you want to add. are three key things that are in foods that are not specific foods, but they're in specific foods, which are prebiotics, probiotics, and polyphenols. Prebiotics and prebiotic foods are things that provide fiber to the bacteria that they like that we can't eat. I mean, that we can't digest. So they're just food for them. And they're in all sorts of plant foods. Some artichokes, regular artichokes, plantains, asparagus, a lot of foods have a chicory root, a lot of foods have these prebiotic fibers that can be consumed as part of our diet. And just fiber in general, high fiber diets in general are good for the bugs in your gut. Then there's prebiotic foods, which we just talked about, and there's probiotic foods. So there's sauerkraut, miso, natto, tempeh, you know, just things that are fermented that have been around for a long time, that have been used to preserve food that end up actually having probiotics in them. and we barely eat any of those anymore. Pickles and pickled vegetables. Even pickles, I grew up on pickles, but pickles count. And then the third are polyphenols, which is sort of a new discovery that good bacteria like to eat these colorful compounds in plant foods. The reds, yellows, greens, purples, oranges. And the more you can include these polyphenols from a colorful rainbow colored diet actually helps fertilize the good bugs. Bugs things like cranberry, pomegranate, green tea, turmeric, various kinds of compounds that we can get is just part of our diet, help fertilize and help gut. So, yes, it's cutting out the bad stuff and it's actually eating gut supporting foods.

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

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

When somebody comes into the Ultra Wellness Center, one of the things we do is we, every person that sees the doctor has to work with the nutritionist as well. And so we assess their intake. What are they eating? How many, you know, what's their nutrient intake like? But then we also have to assess how are they digesting and absorbing? Because it's not just what you're eating, but how are you digesting and absorbing those nutrients? And then we do a really careful analysis of somebody's nutritional status. So, you know, you can look at functional markers of B vitamins and get a really better understanding of what somebody needs. You can get, you can really look at levels of fatty acids. in, you know, fat soluble vitamins in their body. You can get a good sense of mineral levels in their body, protein levels, amino acid levels. And all of these things are important to assess. So you get a sense of not only is the person eating enough, but are they absorbing well enough to assimilate these nutrients and have enough in their body? And of course, some people just genetically need more. That's what's so fascinating about nutrigenomics, right? We're learning about how some people just need more vitamin D than other people. Even, you know, their blood level may look fine, but they may do better with more. And the same thing with things like vitamin A. So there's genetics that are involved here as well that influence our individual need. so this is an area that we can really influence significantly and help people's health improve.

Yeah, you know what's fascinating? Some of the data I've seen about why we are so overweight.

And what's fascinating, and they've done controlled trials with this, where they'll take people and say, okay, eat as much as you want of nutrient dense food, like eat 14,000 avocados or 10 pounds of broccoli or 20 chickens, whatever, you can.

Eat as much as you want.

And then they say, okay, Another group.

You eat all this other food, which is the typical American diet, which is more processed food, and you can eat as much as you want.

And what they found was that the.

People who ate the processed food were hungrier and they ate 500 calories more a day, which is interesting that when you eat nutrient-depleted food, you want more food. And this is the body's natural intelligence trying to accommodate for looking for nutrients, but they're looking in the wrong places. So we remember there's this thing we learned about in medical school called pica, which is where kids will eat dirt if they're iron deficient, right? Just like animals will go to a salt lick or lick. I mean, I remember being in Bolivia and Peru on the beach and there was this mineral rich like deposits on the beach and the birds and the animals just were flocking to go get these minerals and nutrients, which they knew they needed. well, we try to do the same thing, except when we go to get the, the Twinkies or we get the Doritos or we get the whatever Coca-Cola there's nothing in there. And so we keep looking and looking and looking. We're looking in the wrong place for the nutrients that we need to optimize our health. And, and I think, you know, I, I just so frustrated with, you know, even, you know, highly educated doctors, nutritionists and. Even the government is just not talking about this sort of incredible pandemic we're having of malnutrition in this country. And in fact, some of the most rampant malnutrition is in the most obese populations, especially in kids. Now, I'm not shocked when we rarely get virgin patients in our clinic, which is what I mean by virgin is someone who's not already focused on their.

Health, who's not already eating well.

Like we already get the people who are trying to do all the normal stuff. So we get the cases that are the hardest cases. But a few times in my career, I've had these sort of virgin patients who just show up and they're like, well, I'm just sort of the average Joe and I'm eating American diet. This one kid, he had ADD and.

I was just blown away by the.

Level of deficiencies that this kid had and his poor nutrition because he ate junk food and processed food. He had severe omega-3 deficiency, severe folate deficiency, B6 deficiency, zinc deficiency, magnesium deficiency, vitamin D deficiency.

I was like, wow.

And then he had all these other things in his blood, like trans fats and all this inflammatory stuff. And I was like, this is just incredible that we're seeing this level of malnutrition in America today.

Yeah.

And I think you're absolutely right.

It.

Is impressive, negatively impressive. It's really sad just to see the level of malnutrition that we are seeing. And I think that because our food is so processed and devoid of nutrients and people are just eating more and more of it to get what their body needs, that's why we're seeing so much obesity. So, you know, the first thing we always focus on with people is to say, make sure that everything you are eating is as nutrient rich as possible. Because, you know, unfortunately, like you mentioned, this, you know, the, the, our, our mineral deficient soil and the farming practices and, and everything, it's, it's really stacked up against us. So we really need to think about it. You don't want to waste your calories on on food that doesn't have all the nutrients that your body needs, because that's just going to help you feel better and help everything work better and help our skin look better and help make it easier to maintain a healthy weight and have better energy and be able to go out for a run and be able to focus in school. I mean, it's impressive what we see when we just clean up somebody's diet, but also do those special evaluations to really look and see. And I am, I am like you. I'm always amazed by the deficiencies we see and what gets missed when somebody just goes in for their yearly physical and they have a CBC and a metabolic panel and people aren't looking.

Yeah.

Dr. Dr. Zell's all your tests are fine.

You're great. Everything's good.

Don't worry.

I'll see you next year. But when you lift up the hood and you look underneath, which is what we do with the UltraWellness Center, we test for omega-3 fats, we test for vitamin D, we test for zinc. we test for magnesium, we test for the B vitamin pathways, B12, folate, B6. We do all sorts of sophisticated testing using blood and urine. We look at the genetics that are involved in nutritional status.

I mean, how do we know if.

You need more folate or these B vitamins or whatever vitamin D, you might have unique needs that we can actually test for by looking at some of these enzymes that are requiring you to have increased amounts of these nutrients. And, what's really exciting to me is we really have the potential to really change the health of America by focusing on nutrition quality. In my first book, All It's Prevention, I talked about the nutrient to calorie ratio. Like how many nutrients, how many calories? Coca-Cola is terrible. There's no nutrients, tons of calories. Broccoli is awesome. There's tons of nutrients, no calories. So it's pretty simple way of thinking about it, but it helps you sort of crystallize the fact that we need to really upgrade the quality of our diet and to do the right diagnostic tests. What I like to do, Liz, just as kind of for sort of a mental exercise, is to go through with you the common nutritional deficiencies and talk about how they show up for us in terms of symptoms and signs. You are really critical in the nutrition curriculum at the Institute for Functional Medicine. You're an RD as well as an MD, and you helped design the nutrition physical exam. which is kind of a novel concept for a lot of people. But in Cleveland Clinic, we started teaching it to the medical students, which was great. And essentially it's a way of looking at what are the common ways we can tell for people listening, how do you know if you're nutrient deficient? I mean, yes, you can go to a functional medicine doctor. Yes, you can come to the Ultra Wellness Center. You can see one of us. We can get all the testing. But there's some kind of simple things that you can do to test and, and simple questionnaires that you can fill out to figure out, are you deficient in D or zinc or B vitamins or. or omega-3 fats. So take us through some of them. Let's just start with omega-3s, magnesium, and vitamin D. Those are big ones that we see. Tell us about how you would include in people whether they had a risk for that and whether that's a problem.

So omega-3 deficiencies are so common. In fact, we check so many people for their omega-3 levels. So we do a finger prick that is called an omega-quant. And what that measures is the amount of omega-3s within the red blood cell membrane. And even with people on fish oil supplementation or people who eat a good amount of fatty fish, salmon and sardines, we still see low levels. We still see them being below what we optimally want them to be at. So you want to be at at least 8% of your red blood cell membrane made up of those omega-3 fats. So I'm amazed at how frequently we see that. But what signals to me, okay, we've got to think about Omega-3s other than everything. So we think about it so much. But if people have brain issues, right? Problems with focus and cognition and mood, memory issues, we think a lot about Omega-3s. We think about Omega-3 fats when people have inflammatory disorders like asthma, because low levels of Omega-3s can result in increased inflammation in the body. And we think about Omega-3s when we're dealing with people with issues with their hair and their skin. If their hair is dry, if their skin is dry, if they've got the bumps on the back of their arms, we think, I'm thinking, okay, what's their Omega-3 levels like? Chicken skin, right?

Yeah.

Is it just, are they not getting enough or are they not absorbing enough? so those are the reasons. Of course, if their cholesterol pattern looks bad, if they look like they have signs of insulin resistance, high triglycerides, low HDL, I'm thinking, what's their Omega-3s? I've got to give them more. So those are just some of the reasons why I know I need to give somebody more Omega-3 fats. Yeah, right. If you have dry, itchy scaling skin.

Or flaking skin or cracked or brittle nails, like my nails are so strong.

Because I take Omega-3 fast. earwax, you have really hard earwax, dandruff.

Joint pain, constipation, like you said, mood, attention, memory, blood pressure issues, PMS, all these things are kind of clues that you might have a deficiency. And then, of course, we test through the OmegaCheck or other lab tests. So, that's really helpful. So, you can literally, by virtue of just looking at your own symptoms, tell.

A lot about what's going on. One of the things that happened to me when I was young, I mean, I had pretty normal gut up until I was about 36 years old. and then I got mercury poisoning from living in China. And, that completely screwed up my system. And, I don't know what exactly happened, but we do know that heavy metals and other toxins can interfere with gut function and your immune system and cause leaky gut and affect your enzymes and do so many different things.

So, I went from one day to.

The next from being normal to feeling like I was basically inhabited by an alien where they were blowing up a balloon in my stomach, My, my, literally my stomach was so full of gas, I couldn't release. It was so painful. I felt like I was gonna explode. I developed horrible diarrhea, undigested food, my stool. I developed all these other secondary problems as a result, rashes all over my face, chronic fatigue, muscle aches. And my gut was just at the center of this problem. And I, and I literally struggled to get it to work for a long time until I figured out that the mercury was a big factor. and then I got rid of the mercury and then my gut started to function better.

And just for context, you know, you.

Were living in at the time, I think it was Shanghai.

China.

I was living in China and Beijing.

And Beijing. And it was a pollution, I guess.

And I just.

And they have like a lot of.

The coal factories, which that's where a lot of the mercury is.

Yeah.

I mean, Beijing has people all who heat their homes with raw coal. Like it's not a factory. It's just people like instead of like they're, they're, you know, they turn their thermostat, they have a coal burning stove. That's how they heat in the winter. And you've got these huge inversions and you can't see the building across the street on a sunny day. because it's so polluted with coal.

Wow.

But, but, but I was very susceptible to it. And that was the first thing. And then, and then I, you know, really had to learn how to reset the gut. And that's what I've been doing in functional medicine.

And then a few years ago, I got mold poisoning. So I'm. So that happened. You got better. You found functional medicine.

You were good. You were smooth sailing. And then a few years. And then, and then I, you know, you know, I had a house. It's a barn, and I got mold in it, and, and I had a really bad mold, and I had terrible cough and just really kind of symptoms from it. At the same time, I had a tooth that went bad in the root canal and had to have that pulled, then needed an antibiotic. And so I took an antibiotic called clindamycin, which is common for dental treatments, but it also is one of the biggest causes of something called C. difficile or Clostridium difficile, which is a terrible intestinal infection that kills over 30,000 people a year. And it's quite dangerous. so that's what I had. It developed into a full-blown colitis, and. And my stomach just went Haywire, and I couldn't fix it. And I I did my stool test during that time. And, you know, Drew, I I have looked at more poop than you could ever imagine in your life, probably 30, 000 or 40, 000 of these tests. And mine was probably one of the worst I'd ever seen in my entire life. Like, of all the tests that I'd.

Seen, it was so terrible.

Which means what? Which means my inflammation levels were high.

All the.

The biomarkers, my gut healthy bacteria were gone.

It was.

It was just. It was chaos in there. There was no good guys, was all bad guys, was all inflamed and nothing was working. And so, so basically, you know, tried to figure out how to get healthy again. And, and, and it was really tough because I was having, then I, then it developed into a full-blown colitis and I developed 20 bloody bowel moments a day. I lost 30 pounds. I was just a mess. And I, you know, I was on the way to dying, literally. And I could barely eat. I was nauseous 24 7, had severe gastritis and. from taking all the anti-inflammatory so I broke my arms. It was like this whole perfect storm. And so I ended up to reinvent how to fix myself. That's when I really began to look at, you know, what do we now know that we didn't know five or 10 years ago about how do we reset the gut? And so, yes, it was getting rid of the mold, but also for me was, was really understanding how to put together the right cocktail of ingredients to one, heal my gut and to get rid of the bad stuff, but also to add in the things that really are needed to restore the microbiome. and so I, I came up with a cocktail of things, including polyphenols, which we're going to talk about, which I think were a much neglected area of research around the gut, which is a bacteria like to eat all these colorful plant compounds called polyphenols. These food is medicine. And then one of the other things that could be helpful, immunoglobulins and Prebiotics and probiotics and just kind of what is the right cocktail of stuff to reset. When I started using that myself, I kind created out of all the things that I've known in functional medicine, it was a miracle. Then I started using it on patients.

And I was like, wow, this stuff really works.

Because, you know, I always guinea pig myself first, and then. And then I try to see if it works for people. And it was amazing. People would say, this is the first time my gut's been normal. I have no more colitis.

My.

All my IBS is gone. I feel amazing, and my poops are normal and perfect. And I was like, fantastic. You know, this is great. And so then we started talking about how do we. How do we help people get 'cause it was a lot, it's a lot of hassle to put all this stuff together.

Right, and it's a lot of products from a lot of different places. And yeah, you've had a blog post out for a couple of years now based on that experience. And by the way, I was around during that time and you were in and out of the emergency room a couple of times. I was in the emergency room. At one point in time, honestly, we thought like, was this guy poisoned by somebody? Like, were you poisoned by some nefarious actors or the industry or whatever, because they're trying to take you out? It was really mind blowing, but like you said, it was the perfect storm of things. But it actually, in classic Dr. Hyman style, you kind of became the guinea pig again and it led to this whole other journey of you going deep down the rabbit hole and through these-.

And now I have perfect poops.

One of the biggest reasons that we see that people get imbalances or dysbiosis imbalances in their gut bacteria are antibiotics. I mean, when we over-prescribe antibiotics or people have been on large courses of antibiotics for certain reasons, you know, chronic infections or they just, you know, they got on too many antibiotics when they were younger, what happens is it can result in this imbalance in the good and bad bacteria in our system. It can get rid of some of the good bacteria and fungus, yeasts and things that keep that ecosystem in better balance. so, you know, too many antibiotics, too many antibiotics in our food supply. We know that things like that stress has a huge impact because stress in our life impacts our motility and how well things move through our system. So, you know, we know that people get bloating, you know, not just that this isn't just SIBO, but bloating because of, you know, sometimes if they're They're eating too quickly. They're not digesting their food properly. So they are swallowing air or eating too fast.

Probably that's what I do.

I eat too fast.

I might explain some of my issues. So yeah, moving on to the next thing.

Right, right. So, I mean, and then there's things like lactose intolerance, which is, lactose intolerance is so common. That's the decrease in that lactase enzyme that's in our intestines that breaks down lactose. And when we don't have enough of that lactase enzyme, then we can't digest our lactose very well, which is in dairy, you know? And so we've done a lot of different podcasts on dairy and all of the issues, but what we know is.

That.

For everybody, by the time they reach 100, they become lactose intolerant, you know? So everybody in the whole world is that way. And some people become lactose intolerant.

So no cheese after 100?

Some people become lactose intolerant at age two, some people at 30.

I was just in Sardinia and I saw these little 100-year-old people eating a.

Lot of goat cheese and sheep cheese.

And we're doing good.

Well, you know, what do we know about, when we say lactose intolerant, it's important to recognize it's a spectrum, right? So that there is, you know, when you're, you know, what does it mean to be lactose intolerant? It means you're not as tolerant to digesting as much of the lactose. that's what gets people so confused all the time about foods and food sensitivities. They're like, well, I ate that yesterday and I was fine, but then today I'm really struggling. And it's really because of the volume. Many times you can get away with a certain amount of lactose. And then other times, if you have two servings or whatever, then it pushes your body over the edge because you don't have enough of that enzyme to digest it. So it's a spectrum and that's what we see all of the time. It's also important to recognize there's other things that can cause bloating, things like constipation can cause bloating. We know not having good motility, maybe because of autoimmune processes or just a gastroparesis, like diarrhea, not good motility. Right, exactly. If your bloating is all the time or if it's not getting better, you really want to get evaluated because there are some cancers that can cause bloating and GYN issues, gynecological cancers. So there's more things that can cause bloating. It's important that we pay attention to all of those when we're getting a really good history and timeline from our patients.

I agree. I think there are certain things we see commonly like the bacterial overgrowth. It's often because of people taking antibiotics or other drugs. In fact, one of the things that people really don't realize is that the.

Acid blocking drugs, which are the third leading class of drugs sold in America.

These are like Prilosec, Protonix, Nexium, Mass.

Effects, all those drugs, they're given all.

Like candy and they cause bacterial overgrowth.

And they cause fungal overgrowth because they.

Change the pH, they change the environment.

While you may not have heartburn, you.

End up getting irritable bowel. That's one of the side effects of these drugs. So, I think it's important for people.

Taking those to realize they're not lifelong drugs. There's ways to fix the underlying problem. And, the other thing that I found.

Often is these sugar alcohols that are.

Now in all these healthy products that.

Are highly fermentable, non-digestible sugar alcohols like erythritol, xylitol, sorbitol, maltitol, and they are.

In a lot of these foods. And some people do fine with them, some people don't.

But I know if I have a.

Way back when, I think it was.

Like 20 years ago when this stuff was just coming out, someone gave me.

This, like, sugar-free chocolate bar, which is full of maltitol. And I ate the thing at Kenyon Ranch, and I literally couldn't see patients.

The whole afternoon because my stomach just was going crazy. You were doubled over in pain, right?

Oh, my God.

And then, you know, I think you've got other things that I found clinically. You want to, you found this, too.

Is, I don't know how much document this, but certainly it's like tick infections.

Like the B and others can cause.

Motility issues in the gut or heavy metals. So I often, you know, if we don't get better initially, I start to look for other, other factors.

So I think so, so these are really common problems. And, you know, 10 of all, like, loss of productivity in corporate, corporate health.

Care is from irritable bowel.

So it's a huge economic burden on society, and it's, it's the number one reason for visits to the doctor. for anything.

I mean, it's so important about the additives in foods. And sometimes people, you know, that's something you really have to delve in deep with people on and look about, okay, what bars are you eating? What even certain shakes that have, like you said, some of the sugar alcohols in them. Chewing gum, you know, people always forget about chewing gum and how much, you know, that can cause bloating because of some of the sugar alcohols in them. and so you've got to pull those away just to help people feel better. Absolutely. And I think it's a bit of.

A detective job and a lot of processed foods has emulsifiers and thickeners that tend to cause leaky gut and other issues. So there's just so much opportunity by.

Focusing on a very detailed history to figure out what are the culprits. And if you're not eating anything that's.

Real food, if you're anything that's not.

Real food, it could be a thing like fructose is a big factor, a lot of high fructose corn syrup and stuff and people have fructose intolerance.

So there's a lot of issues that.

We can really deal with.

So take us now, those are the.

Causes and those are the things we tend to think about and test for. We test for gluten, we test for.

Food sensitivities, we test for a lot of things.

What would be an approach that we would take typically to deal with these people with the food baby bloating thing? Let's just say it's kind of the.

Typical kind of cancer, Lyme disease, right?

Right, right. I mean, exactly. Right. So you mentioned about the Lyme disease, that's really, I think, important. important when people are not getting better, when they're being treated so many times and they're not getting better. But so, yes, so we often will test for dysbiosis. So we're testing for SIBO. We also do stool testing that is fascinating, just some of the revelations we're having and improvements in stool testing. We can look at levels of good and bad bacteria and balances in good and bad bacteria. and work to shift those as well, which can be really helpful. One of the first things we always start with, of course, is dietary changes. So, you know, we'll either put somebody, depending on their history, their story, and where they are and their level of motivation, we either put them on a dairy-free diet or we put them on a gluten dairy-free diet, or we might put them on a low FODMAPs diet. So FODMAPs, you know, people have, maybe people have heard about FODMAPs and so it's important for us to just sort of delve into that a little bit.

Yeah, what does that mean? What does that mean?

Yeah, so FODMAPs foods are fermentable oligosaccharides, disaccharides, monosaccharides, and polyols. And so these are these carbohydrates that are not completely absorbed for some reason, either because of some mal digestion or just because they're harder to absorb carbohydrates. And then they get, when there's the wrong bacteria in the wrong place, they consume those carbohydrates and produce gas. So, you know, so the oligosaccharides, those are things like wheat and rye and onions and garlic and legumes. Disaccharides are things like lactose and dairy. Monosaccharides are things like fructose, like high fructose corn syrup, like you mentioned, honey and apples. The polyols, those are things like sorbitol and mannitol, the artificial sweeteners, and some fruits contain some of these polyols. And so one of the first things we do is say, okay, maybe we should try a low FODMAPs diet, for a period of time. So there are some foods on this list that are good, healthy foods that you don't want to stay off of forever. So it's usually with a low FODMAPs diet, it's for a period of time that you're taking people off of these carbohydrates that are fermentable and then over time working to reintroduce the healthy ones for that person. The Monash University has a really good website, lots of good resources on FODMAPs foods. But in general, you pull away things like wheat and rye and onions and leeks and cauliflower and apples and dried fruits and sugars and high fructose corn syrups and legumes. You do that for a period of time. Not everybody needs to go to that level. and for many people, it's important that they work with somebody who's a nutritionist or somebody who can help them navigate the world with this because it can be, like I was mentioning earlier, you got to figure out what you're able to eat.

So, Ben, let's talk about some of.

The other approaches besides the dietary restrictions.

That we would take. We might get off gluten, get off grains, get off beans, get off sugars, get off all the things that you mentioned. Then, you know, what do you do.

For the bad bugs? How do you reset the gut? How do you sort of rebuild the gut?

Oh, great question. So, you know, depending on what's going on in terms of the dysbiosis, right? Dysbiosis just means imbalance in good and bad bacteria and yeasts. And depending on what we find is going on, we will treat that. And so we can treat that with a prescription medication. So sometimes we'll use an antibiotic. I know that sounds kind of crazy because you're like, Counterintuitive, right? Yeah, we're like, wait, we know antibiotics cause dysbiosis. True, but sometimes if people, depending on their level of symptoms, they do, you know, we can improve symptoms with a short course of a non-absorbed antibiotic. So sometimes we'll use an antibiotic for a period of time and then we'll use an antifungal medication.

And then there are other- Dr. Because.

You always follow the antibiotic with antifungal.

Yeah, I mean, I often do. And again, it depends on what I find with the testing we do through stool testing and breath testing and their clinical situation. So I often will follow with an antifungal or I'll follow with an herbal medication that includes that there are many different herbs that they have affected both treating bacteria and yeasts. So we can use some herbal regimens. There's a lot of good ones out there that will treat both bacteria and yeast overgrowth. And that's one of the nice things about herbal regimens I find is that when you're resetting the bacteria in the gut and the yeast in the gut is you know, they may be a little slower to act, but they sometimes are really effective long-term. So there's a few herbal regimens that we use very often, and some have been really well studied. We also do things that help the body with digesting your food. So whether that's something that increases acid in the stomach, like betaine HCL or a digestive enzyme, there's digestive enzymes that are plant-based digestive enzymes. And then there are other digestive enzymes that are, you know, they come from their porcine, their glandular digestive enzymes. Those things help with breaking down your food, your protein, your carbohydrates. They help with breaking them down so that they're easier to absorb into the body. and less likely to feed the dysbiotic bacteria that we were talking about. So, that's great. You know, that's also really helpful.

So, I think the unique thing about.

Functional medicine is that you not only just sort of get rid of the bugs, but you focus on resetting the whole gut. And, you know, whether it's an antibiotic, antifungal, and herbs, and I'd love you to talk about what herbs, or then you add in enzymes and other pre and probiotics and repair components.

Components for the gut.

It's what really helps people get better.

I hope you enjoyed today's episode. One of the best ways you can support this podcast is by leaving us a rating and review below. Until next time, thanks for tuning in.

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