How To Get Rid Of BELLY FAT & BLOATING With Functional Medicine | Mark Hyman & Dr. Elizabeth Boham

If you suffer from bloating, if you have this food baby, if you're really miserable and uncomfortable, there is a way to kind of get through it and fix it.

If somebody does have an overgrowth of bacteria in the wrong place, sometimes probiotics make that worse.

So I'm the average Joe or Jane, and I go to my internal medicine doctor or my GI doctor, and I go, Hey, doc, you know, I got bloating. And every time I eat, my stomach.

Feels like it's going to explode.

I just feel really uncomfortable. what do I do? And up until fairly recently, it was like, well, you have irritable bowel, it's probably psychological, take some metamucil, and hopefully that'll work. And if that doesn't work, we'll give you some antispasmodics for your stomach so it doesn't spasm. And otherwise, go meditate or take Valium or Prozac. It's not a very satisfying answer for a lot of people.

Yeah, a lot of people walk away dissatisfied and they're frustrated and they they don't feel good. And, you know, like you were mentioning before, it's not always something that's causing death for people, but you know what? Sometimes it causes significant issues. Like, you know, I have patients who come in and they have such significant bloating that it's stopping them from being able to eat enough nutritious food. So they've had to really restrict their diet or they don't feel like eating so much. And I have some patients, and we'll talk about one later where where they're getting thinner and thinner and they're losing their lean muscle mass because the amount of bloating they're having is restricting their intake of nutritious food. And that can be really significant for people. I mean, that doesn't happen to everybody, but there are people where they're dealing with it. That's a significant issue.

No, it's a big issue.

And it's estimated that 20 to 30% of the population is dealing with bloating on a regular basis. People with irritable bowel syndrome, it's 96%. So people who are struggling with digestive issues or irritable bowel, as we've talked about before, that is something that we really work to define greater than just putting that into a waste paper basket, right? It's even higher. It's at 96%. So bloating just means that your belly is getting bigger, right? You have this increase in abdominal girth and it and it typically, when we're talking about abdominal distention from gas or bloating, what we're going to talk about today, it increases after you eat. So people will feel more bloated after they eat, or they may feel more abdominal fullness or sensation of gas as the day goes on.

And.

There'S so many reasons behind the causes of bloating, and I think that's really what we want to focus on today, you know, is what we really work to get to that underlying root cause in functional medicine, right? What is that underlying cause for that person? Because there's so many different reasons for bloating. And I think that's really critical to focus on and not just saying, okay, well, take Gas X or just take something to suppress the bloating. We really want to figure out why is it going on because that really then can help work on that person's of symptoms that are causing them a lot of discomfort.

And I think, you know, when I was in medical school, we didn't really ever learn about what we call SIBO or SIFO. We didn't learn about that. Did you learn about that?

No, not at all.

It was kind of a new insight about irritable bowel, which is that it's really about the often, not always, and we're going to go through the causes, but it's often about the overgrowth of bacteria or fungus yeast in the small bowel. Now, you've got like 22 feet of, you know, small intestine, about 10, 12 feet of large intestine. The small intestine is generally sterile, but sometimes the poop from the large intestine kind of migrates up and we'll talk about the reasons for that and leads to the spectral overgrowth. So some conventional doctors now are treating people with antibiotics, right? What kind of things are you seeing them do?

Right.

So you're talking about SIBO. So, you know, We're checking one of the major causes of bloating is SIBO or small intestinal bacterial overgrowth. And as you mentioned, there's a lot of other reasons that people get bloating, but one reason could be because there's the wrong bacteria that have migrated up into the small intestine, as you have mentioned. And when that happens, that dysbiotic or not good bacteria or the bacteria that shouldn't be there consumes some foods and then produces gas. so it's consuming foods that.

Get fermented.

Get fermented. And then you produce a bunch of gas from it. And so the combination of certain foods and not always bad foods, but certain foods that cause this gas when there's the wrong bacteria in the wrong place can cause a lot of bloating. And so, you know, SIBO is something we check for all the time. You know, you can check for it with a breath test. Conventional doctors are checking for it as well. We check for it all the time. all the time. Yep, now they are.

And.

There'S a few ways you can work on treating that, and we'll delve into that more. But one is getting rid of the bacteria that's in the wrong place. And you can do that with medication like antibiotics, like you mentioned. You can do that with herbal substances that lower the bacteria in the wrong place. And you can also change the diet for a period of time that takes away the food that's feeding this wrong bacteria that's allowing it to overgrow.

So that's good. So, so, so conventional doctors are sort of getting the point a lot about SIBO and they're using antibiotics and then they'll use, you know, different diets to, to restrict the fermentation of the foods, but they really don't have a comprehensive 360 approach from my perspective. They don't deal with the overall ecosystem of the gut. They don't look at all the other food sensitivities. They don't look at how to repair and rebuild the gut after the problem is taken care with antibiotics. And they, these often people, they don't often treat yeast or SIFO, which is often coexisting with the SIBO. and then they end up having recurrent bloating. So that maybe get better for a few weeks or a month and then it comes back. So functional medicine is a very different perspective.

And.

We understand the problem, but then we also understand how to navigate like medical detectives to the cause. And what I think is challenging with SIBO is it's such a persistent and uncomfortable thing and there's not a lot of insight about what really happens. So I would love if you sort of take us through what are all the types of reasons people can start to develop SIBO and all this and develop this fermentation process? Because by the way, the thing that struck me was such a big insight was humans don't make gas. It's the bacteria eating the food that you eat that make the gas. So, if you have gas or bloating and you have distension and air in there, it's not you making it, it's the bugs and it's an imbalance in your relationship with your bugs. So, you gotta get in harmony with your bugs, basically. so take us through, Liz, what are the common reasons why we get this bloating and dysbiosis and imbalances in the bacteria?

I mean, 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 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, 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, this isn't just SIBO, but bloating because of, you know, sometimes if they're eating too quickly, you know, they're not digesting their food properly. So they are swallowing air or eating too fast.

Probably that's what I do. I eat fast. I may explain some of my issues. Yeah, moving on, right.

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 a hundred, they become lactose intolerant, you know? So everybody in the whole world is that way. And some people become lactose intolerant at age 20.

So no cheese after a hundred?

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

I don't know. I was just in Sardinia and I saw these little a hundred year old people eating a lot of goat cheese and sheep cheese and we're doing good.

Well, you know, and 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. And 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, right? You can, you know, many times you can get away with a certain amount of lactose, right? And then other times, if it's, if it's a, 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, you know, it's a spectrum and, and, and that's what we see all of the time. You know, 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, you know, maybe because of of autoimmune processes or or just a gastroparesis like not not good motility. Right. Exactly. It's 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 mean, I think there are certain things, we see commonly 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, okay? prilosec, protonix, Nexium, mass effects, all those drugs. They're given all that candy and they cause bacterial overgrowth and they cause fungal overgrowth because they change the pH, they change the environment. And so 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, to realize they're not lifelong drugs. There's ways to fix the underlying problem. And the other thing you know, 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 is, but certainly it's like, 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 started to look for other factors. So I think, so these are really common problems. And, you know, 10% of all like loss of productivity in corporate healthcare is from irritable bowel. So it's a huge economic burden on society and 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. People always forget about chewing gum and how much 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, you know, 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, you know, 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 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, but we also do stool testing that 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 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 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.

But FODMAPs- 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 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. And 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 sort of approaches besides the dietary restrictions that we would take. We might get off gluten and dairy, get off grains, get off beans, get off sugars, get off all the things that you mentioned. Then, 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, depending on what's going on in terms of the dysbiosis, right? Dysbiosis just means imbalance in good and bad bacteria and yeast. 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, 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- 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 we have, they have effect at 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, 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.

That's great.

You know, that's also really helpful.

So I think the unique thing about functional medicine is that you, 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, any fungal and herbs, and I would love you to talk about what herbs or then you add in enzymes and other pre and probiotics and repair components for the gut. It's what really helps people get better.

Right.

So tell us about, tell us about the cases you had a 35 year old guy. quite a remarkable story.

Yeah, so, you know, there's this gentleman, he was 35 and he came in to see us and he was really frustrated with his bloating. And, you know, what he said is that, you know, he felt fine in the morning and then as the day went on, he became more and more distended. He became more bloated in his belly and distended. And so it's really important, as I said, that we get really detailed clues as to his history. And, you know, you know, what really helps many times is when people take that really detailed history, you know, and they think about their own timeline. When did this start? You know, how long has it been going on? You know, trying to help get the clues as to what triggered this to occur for them, right? And, you know, so we knew that as a child he had ear infections, so he was on multiple rounds of antibiotics. But then two years ago he developed a pneumonia. and he ended up the first round of antibiotics wasn't helpful getting rid of his pneumonia and he needed a second round of antibiotics. And so we can also need to delve into this, you know, this risk for pneumonia here and everything, but it was that, you know, those recurrent rounds of antibiotics at that point, since that point, he's been struggling with bloating. So, you know, he's been really, at that point he started saying, okay, now every time I was eating, I was getting more bloated. And prior to that, he could eat whatever he wanted. He really didn't have to be careful with his diet at all. Now, if he noticed if he ate too much dairy, he would get bloating and diarrhea. We did do a SIBO test and it was negative. But while we were waiting for his stool test to come back, we We just decided, okay, let's pull away gluten and dairy. He wasn't really ready to go on a full low-FODMAPs diet, and I didn't even know if it was really necessary for him right away. So we said, okay, let's pull away gluten and dairy. And when we did, he had significant improvement in his symptoms, but not complete improvement. He still would, he felt better, but he still was getting some bloating depending on what he ate. And so the stool test came back, and it was really interesting. a dysbiosis, right? It showed an overgrowth of many different bacterias and some yeasts. And so we then treated him with an herbal regimen. So we used something that had a combination of different herbs, oregano, berberine, it was a combination product. And he took it for six weeks and he found that extremely helpful. We did add in probiotics. We did wait to add in probiotics till we were done with his herbal regimen. But once we did add in like a general probiotic and there's so much to discuss with probiotics, but he found that to be really helpful and.

Now.

He'S back to, I mean, he really is careful with dairy and has a really good healthy diet, but he's really much more comfortable all the time now.

Well, let's talk about that. I mean, the probiotics, you know, can be problematic.

If, you know, a lot of people.

With irritable bowel, they go, oh, I'm going to take probiotics. They go to the drugstore, they go.

To the health food store, and they.

Get the probiotics, and they take them, and often they get worse. Yes. So, you know, can you explain that.

There'S an important order to doing things and that what would be beneficial at one point might be harmful at another point? I think that's absolutely true. You know, order is really important. And, you know, if, if somebody does have an overgrowth of, of bacteria in the wrong place, sometimes Probiotics make that worse, you know, and you can get, if you take a probiotic and feel more bloated or your digestion doesn't feel, it feels worse, not better, then that's the wrong probiotic or the, or could be the right probiotic, but at the wrong time. So it's really important that, that you're either working with somebody who knows what to, how to recommend what order of things to do it in, or.

Just.

Knowing that if it doesn't feel right to you, put it on hold. There's lots of different brands of probiotics out there and quality of probiotics out there. Some probiotics have dairy in them and so for people who are dairy sensitive, they don't work, other ones don't. There are also some strains of probiotics that can, in of themselves, depending on the milieu, increase the amount of bloating for certain people. There are, it's, it's, it's, it's hard to give a general recommendation. Like, I, it's hard for me to say, well, take this one, because it doesn't work for everyone, but just know that if you try one and it makes you feel worse, put it aside. And it may be that it's just not the right one for you, or it's one to try at a later date, after you've gotten rid of the dysbiotic bacteria. Some people get the, get a probiotic and they feel better right away. And then that's a, that's great. Wow.

Yeah, it's complicated. So, if you're struggling with this, don't lose heart. There's a lot of things. I mean, you didn't mention histamine intolerance. There's a lot of things that cause problems, which we've covered a lot on the podcast. But, the key is that if you suffer from bloating, if you have this food baby, if you're really miserable and uncomfortable, all that, there is a way to kind of get through it and fix it. You want to know my secret for living a long and happy and healthy life? Well, all I have to do is check out my weekly newsletter, Mark's Picks. where I share my favorite tips for health, longevity, well-being and lots more. Check it out and the link below. You also, I think you had one other case of a woman who was 25 and was also struggling.

Yeah, so yeah, I mean she had.

Classic history, kind of.

Lots of antibiotics for, she had acne, so she was on lots of antibiotics for, you know, between the ages of 17 and 22. And this is what we were talking about before. Her bloating was so significant at this this point, that it was preventing her from doing things. She wasn't, you know, getting out during the day. She wasn't seeing friends all the time. She also couldn't eat as much. So, and just with her body type, if she wasn't eating enough calories or enough protein, she was starting to lose weight and she was getting underweight. She was also losing lean muscle mass. And this then creates this vicious cycle because if you don't have enough nutrients coming in, then the body can't heal. I always talk to people about that. People are always restricting foods, which the elimination diets can be so helpful. But sometimes if we're eliminating, eliminating, eliminating, and then not getting in enough nutrition, then the body can't heal. And this is what was happening with her. She was eliminating so much that she was wasting. Her lean muscle mass was decreasing. She was feeling more weak. and she- if you feel bad when.

You eat, you don't want to eat. And so you just didn't eat.

Exactly. So she was just not eating. And she was more constipated. We did a SIBO test on her. It was positive. It was positive for both methane and hydrogen SIBO, but much more positive for the methane positive SIBO.

Yeah, we'll talk about that.

So we do this testing, which is.

You breathe in, you breathe in this, you just drink this liquid that tends to cause the fermentation, right? And then you breathe into this bag. and you can tell whether it's hydrogen or methane and each are different and they actually respond to different treatments. So it's important to know which type of gas you're producing because that means it's different bacteria and so you need different drugs or different herbs for different bacteria.

That's so true. That's so true. So what we know is that there's the methane producing bacteria are more likely to cause constipation, right? They're more likely to impact the motility in the digestive system and cause more constipation. And so the hydrogen producing bacteria are more likely to cause diarrhea. Now, that's not always the case. Like sometimes people have, you know, their testing looks one way and it doesn't always match up. But in general, we see the methanobacteria, the methane producing bacteria, more likely causing a constipation picture and bloating. And so you're right. So sometimes we, you know, the medication, there's a typical medication that is used, prescription medication that's used for SIBO called Xifaxan. But when you find the methane producing, it typically works better when you use it with neomycin together. You use both together. And she also did well when we put her on that low FODMAPs diet. you know, we really pulled away. She needed a nutritionist on board because as we were mentioning, she was becoming underweight. So she really needed somebody to guide her through. And as you know, at the Ultra Wellness Center, you know, we've got all our nutritionists working with all our patients, which is wonderful. And so, you know, they were really, you know, her nutritionist was really helpful to guide her through the pulling away of the foods that were making her feel worse. but then getting her the nutrition she needed. And then slowly transitioning over time so she could add back in those healthy, higher FODMAP foods, like the onions and cauliflower and fruits that we want to be able to add back in when possible. So after we treated her and got rid of that dysbiosis, she started to feel so much better. And nutritionally, she responded well. She was able to digest and absorb her food better. which is really important because when there's that imbalance going on, you're not digesting well, you're not absorbing well, she was getting weaker, right? So she was able to digest and absorb better and she was nutritionally getting stronger and healthier and her gut was healing and we could add back in those good, healthy, higher FODMAP foods that she was able to tolerate.

It's quite amazing how many people really struggle with this. how hard it is for people to overcome this and how traditional doctors really aren't that great at addressing this and that there really is a new way to do this, more comprehensive way using kind of the approach of functional medicine and getting people the kind of support they need to kind of rebuild their whole gut. Because it's not just about taking antibiotics and that's it. It's really about a whole gut healing and repair approach that's with functional medicine and also the right kinds of testing and and everything. So I think it's super important to, to, to understand for people listening that this is not something you have to live with your whole life. This is not just who you are that, you know, it's really, really important to actually dig in and, and figure it out and, and get to the bottom of it.

You made such a great point there, Mark, about the comprehensive approach, and I think that's what we need more of in healthcare. and it's really important in this situation that people get all of that comprehensive care with having a nutritionist on board, somebody they can check in with regularly, you know, that's really following up with how they're doing and really digging in and finding that underlying root cause for them. It's so much more successful than that knee-jerk approach, you know?

Completely, completely important. Wow, well, you know, I think for those listening, if you've experienced bloating and then, and if you know what I'm talking about or what we're talking about, then it's important for you to take this seriously because it's not just something that is annoying. It actually indicates that your overall microbiome is out of balance and your health of your microbiome determines your overall health and longevity. So it is annoying, but it's also more than that. And so really working with the right practitioner, getting the right kinds of testing and diagnostics is so important.

Hey, YouTube, if you like this video, you're gonna love the next one. Now, I always say if I were stranded on a desert island or a deserted island and I only had one drug or tool to bring with me as a doctor to treat my patients, what would it be? It would be an elimination diet, which I don't really like the term because it sounds like you're depriving yourself. It's actually an addition diet because you're adding on all the good things and you're taking out the bad things. so that's what we're going to talk about today. We're going to talk about all the various ways in which food can influence our health from the perspective of allergy intolerance and sensitivity. So we know that there's foods that help promote wellbeing and health and blood sugar and so forth, but there's a whole other set of ways in which food interacts with your biology that creates inflammation and that creates chronic symptoms. and that it's not typically like, oh, well, just eat this bad sugar or bread or whatever. It's much more nuanced than that. And I think it's an incredible subject that we haven't really taken a deep dive into, but it really, for me, in understanding the role of food as medicine is really the kingpin of treatment in functional medicine is using food as medicine, not just eat healthy food, don't eat unhealthy food, but very specifically understanding what people's unique needs are and what particular foods for them are causing a problem and why. So, Lisa, tell us a little bit about your first sort of understanding of the elimination diet. As a dietitian, it's probably not something you really learned much about, except maybe as an elemental diet and someone's got Crohn's disease. But what was a light bulb moment for you when you went, wait a minute, this is a game changer when it comes to dealing with chronic disease.

Yeah, well thank thank you for the introduction, Mark. It is great to be here. And no, it's true. I learned a little bit about it in school, but when it comes to how powerful removing certain foods are and adding certain foods in, it's very-- I only learned that once I actually got to here. Got to learn more about functional medicine, learn more about integrative health-- Here at.

The Ultra Wellness Center.

At the Ultra Wellness Center. And, you know, there are many different ways that a person can react to foods. It's not just, as you said, sugar causes inflammation. We know that. But there are these nuances that there are a few different ways I'd like to talk about first being probably the most obvious one, which is allergies. So there's something called immunoglobulins, and these are antibodies that they're designed to protect us against invaders, whether that be in the environment, food. I mean, it goes into our digestive tract, and that is our this line of defense. So if we have certain invaders or the body perceives them as invaders, we need to be protected. So there are these immunoglobulins and when we think about allergies, we think more about like a peanut allergy or a cow's milk allergy.

And this is- Strawberry or shellfish or something where you blow up and you.

Get your tongue swells. Those like top 8 allergens. And those are immunoglobulin E or IgE reactions. so these you think of, you know, sort of immediate reactions. You think of hives, you think of swelling of the lips, the tongue, it more extreme reaction would be anaphylaxis. Yeah, you could die. You could die. It's a very life-threatening potentially condition. So that happens pretty immediate. People realize that they have that pretty quickly.

But there are these other- I was.

Just gonna give a quick story about it reminded me of this patient I had when I was an intern. I was in the emergency emergency room and this guy came driving up to the front of the emergency room and we heard this horn going non-stop like someone had their hand on the horn. Except he didn't have his hand on the horn. He had his head on the horn and he had literally died and his face was in the horn and he drove himself to the emergency room. We brought him in. He was a young guy. We threw him on a stretcher. We put in epinephrine. We put in steroids. We shocked his heart. We brought him back to life. did all the great fun things that we do in medicine. And then we said, what happened? He says, well, I'm allergic to fish. And my friend was cooking fish and I was in his apartment and I smelled the fish. -That's all it took. -I didn't even eat the fish. And I noticed I started to react and I'm two miles away from the hospital. I figured if I waited for the ambulance, I'd be dead. So he jumped in his car, drove there and it's, That level of reaction, that's a true allergy. But when we in functional medicine deal with allergies, we're mostly talking about something quite different, which is a different kind of food reactions. There's a lot of ways your body reacts to food. That's only one of them. And it's not one of the most common ones.

No.

More common are intolerances and sensitivities. So intolerance, this is a non-immune reaction. So the IgE is an immune reaction. Intolerance, a lot of people might think, okay, lactose intolerance, even fructose intolerance or histamine intolerance or intolerance to sugar alcohols, these compounds that are poorly digested and absorbed and can lead to symptoms such as abdominal pain, diarrhea, headaches, and nausea.

Yeah, you eat ice cream and you.

Get gas, your stomach blows up, you feel like bad, you get diarrhea. That's not an allergy. Right, that's not an allergy. It's a little bit different than a sensitivity, which I'll explain, but these, these are a little bit easier to pick up on. The symptoms usually show up within an hour or so after eating the food, like you said, eat milk, drink milk, then you're in the bathroom not too long after.

And there are also these things like other reactions that are not even related to intolerance, like for example MSG or aspartame, which are these excitotoxins. So these are compounds that do have reactions in the body that are not really immune related, they're more related to the neurological effects of the amino acid like compounds that also your brain function, your headaches or make you hyperactive.

All that, yeah.

Yes, exactly.

Migraines. So there's that whole series. And then I would argue probably the most common, but the hardest to pick up on are the food sensitivities. So going back to the IgE reactions, these food sensitivities are IgG and IgA. So just the different way that the body reacts, in fact, IgGs are the most common antibodies in the body.

These are delayed.

It's like delayed.

Delayed. you know, you're gonna know in minutes. Yes. If you eat, you know, let's say you have, you're allergic to, like, I don't know, like, it could be gluten.

It could be gluten.

Or maybe it's, you know, any, you know, eggplant.

Right.

And you feel sick three days later. You're not gonna know.

It can be hours or days.

It can be hours or days later. So you're not always going to connect the dots.

Right.

And unless you're writing everything you eat. I know if you asked me, what did you eat two days ago? Unless you're eating the same thing every day, it's going to be very hard to.

I ate an artichoke.

I ate an artichoke with some sauerkraut. So, no, it's very hard. So if you have these, the other thing that makes it difficult, too, to pick up on this is the symptoms range so broadly. So it's not like, oh, I'm going to have hives and swelling of the lips. It could be anything from brain fog, hyperactivity, it could be depression, anxiety, could be weight gain, could be FLC syndrome, feel like crap, right? And it could be anything else.

Sleep, depression, mood changes, it's so much, right? Hormonal changes, menstrual issues, I mean, so much. Joint pain, joint pain, aching.

And so a lot of people don't associate so many of these symptoms with.

The food that they've eaten.

Dr. Sinus issues, allergies. Dr. Absolutely. Changes, it could be GI, it could be changes to the bowels, it could be constipation, diarrhea, abdominal pain, but again, it's not so acute. Dr. Yeah. Dr. So it's difficult to recognize which foods are associated with that. And we do check here at the Ultra Wellness Center, we do have testing to check for these IgG, IgA antibodies, but there's no one test perfect. There's no one test that checks every way that a food can interact with somebody or cause these symptoms, which is really why the elimination diet continues to be the gold standard. And that's what we do pretty much with all of our patients.

Yeah, there's even another response because what you're talking about is antibody responses that the body creates. And antibodies are sort of like smart bombs. They're specific, right? So you can an antibody to dairy or an antibody to eggs or an antibody to chicken, corn, whatever. But there's another part of your immune system, it's the ancient immune system. It's your primitive immune system, like we call it your innate or cell-mediated immune system. And that creates a sort of a general response and you can't measure that. And it just creates this just generalized inflammation and it can be to anything and also gluten is commonly causing this type of innate immune response which is really hard to measure. So even if you check for gluten antibodies or celiac, you'll miss it.

You may not pick it up. Right, exactly. No, that's very true. And there are many reasons why we can have these types because we're always thinking in functional medicine, why?

Why is this happening? Yeah, so why do people get these weird sensitivities? Because it seems like odd that we would be reacting to all these foods that we should be eating and they're actually probably even good for us. Like, why would you be reacting to an egg?

Yes.

Or, you know, kidney beans.

Or strawberries, like you said.

Strawberries.

It's like they're good for you. Right. Well, there are a number of different reasons. And I would say in relation to sensitivities specifically, number one, you think about what's the variety in our diet? Our diets are becoming less and less varied. Okay, I don't even need to, you know, preach to the choir here, but it just with subsidies and just all of the foods, it's like you go into the supermarket and they're all made with the same five basic ingredients?

Yeah, 90% of our diet is 12 plants and 60% of our diet is three plants: wheat, corn, soy, and rice, depending on where you're from.

Exactly. So the lack of variety really, really is a problem, but also if you're eating a high quantity of certain foods, let's say it is eggs, which eggs are a wonderful food, very high in nutrient density, but they're a higher allergenic potential food. So if you're eating multiple eggs every day and I talk to people who do this because they love it and it's easy and it's quick. But eventually with enough exposure, those proteins can start to become what the body interprets as an invader. So it can begin to develop a sensitivity if there's not enough variety and rotation in the diet. But then you also have to think about the gut microbiome. How balanced is it? Do we have dysbiosis or lack of balance of gut bacteria? and how can that be influencing the inflammation in our gut, the integrity of the lining of our gut, all the things that can lead to leaky gut or intestinal permeability, herbicides, pesticides, overuse of medications, non-steroidal anti-inflammatories, antibiotics, I mean, the list goes on and we're all bombarded.

With this all the time. Okay, you just said something really important, Lisa. You said leaky gut. Leaky gut. So, I want to backpedal on that. Yes. What is leaky gut and why should I care?

Okay. I love explaining this. It's like, you can really get the visual because our gut, really, there's- It.

Sounds kind of messy, actually. I don't know. I don't know if I want the visual on this one.

I'll make it, I won't get too crazy with it. So what we eat- There might be children listening. What we eat and what we drink, we want those things, especially what we eat, to break down to their basic molecules. We want the vitamins, the minerals, the amino acids, all these things that our body needs to be absorbed and we need everything else to get excreted in the stool, urine, all that.

It was like a big filter.

It's a filter, exactly. It's a protector, which is why 70 to 80% of our immune system is in the lining of our gut because so much goes through there. So there's one, there's basically one cell thick that helps protect us between whatever's in there, all the toxins.

It's like a sewer.

Yes, it is a sewer, right? And everything else that gets absorbed, there's this one cell lining that we need to be, you know, we want those cells to be tight together unless we give that, unless we're in a place where those foods are completely broken down and then those gaps can open up a little bit, allow some of the amino acids and all the vitamins and minerals to go through, we absorb them and we utilize them in a perfect world. but all these things we're talking about, herbicides, pesticides, medications, all that, and certain foods can actually cause gaps to form in between the cells inappropriately and allow larger protein molecules from our food, as well as bacteria, viruses, all the things that are in our gut to start leaking through into our circulatory system, into our blood, where it shouldn't be. And then our body sees that as an invader because technically it is. It shouldn't be there. be there. It should be in our gut. And so there's that in and of itself is leaky gut. I think it shows.

I think like so your gut lining is a coffee filter, right?

Yeah.

So you want the coffee, you know, it's good stuff to go through the coffee filter, but you don't want the grounds in your coffee.

Exactly.

So if the holes are too big, then all this coffee grounds end up in your coffee, it's not so great.

Right.

And the reason, you know, the lining is there is to allow the right stuff through and to keep the bad stuff out.

Right.

And what happens with all the things you're talking about are processed diet, pesticides, glyphosate for example, which destroys our microbiome, and the overuse of medications, stress, all these various things cause damage to the gut. And so if you look at the microbiome of some indigenous cultures or people who are living more traditional lives and diets, their microbiomes are incredibly diverse, incredibly healthy, and they don't have allergies. they don't have asthma, they don't have autoimmune disease, they don't have sinus problems, they don't have eczema, they don't have any of these problems because their guts are different and their microbiome is very diverse. It's like a rainforest instead of a monocrop soybean field. And I think that's what we're facing in this country is a devastation of our microbiome. We're worried about the rainforest. We got a rainforest inside of us. Exactly. We should be worried about that.

Yes.

And how do restore that? How do we plant the good trees in there? And I think the whole concept of these food sensitivities is being completely neglected in traditional medicine. It's thought as quackery. The tests are challenging, they can be helpful, but they're not a perfect test. So often, for example, I just had a patient yesterday who we did a test on five years ago. She had 26 different foods. that she was reacting to. It doesn't mean she's allergic to 20 different foods, but she had a terrible gut. She had Giardia, she had terrible bloating, she had irritable bowel, she had all these issues. We fixed her gut and her reactions went down to nine. And in fact, not only did they go down nine, but they were very, very low levels of reaction. And so they were all, and they were only into the things that we knew she was really reactive, like gluten. So it was rye, barley, oats, you.

Know.

Those wheat, those are the ones that she was reacting to. So out of the nine, five of them were like gluten grains, which we knew anyway. So I think the key is you can heal a leaky gut. And if you were allergic to peanuts, you probably want to stay away from peanuts forever. There may be new treatments and so forth that we can modify that, but you don't want to mess with that. If you're sensitive to a food, it doesn't mean that you need to stay away from it forever. You need to fix the cause. And that's what functional medicine really is focused on.

Dr. Absolutely. And I think another point of what you're saying is we're trying to increase and improve the resilience of the body. So the goal is to not keep those foods out that we see on these sensitivities or if you're doing some kind of comprehensive elimination diet, we're not trying to keep those foods out for the next 10 years of your life. We're trying to heal and seal the lining of the gut, help improve the microbiome to the point where you can then be more varied with your diet. Expose yourself to new foods that before perhaps were giving you a problem but won't be as much of an issue down the road. So yes, I think that's a very good point.

It's not just about getting rid of the foods. It's about figuring out why the gut is a mess.

And what can you add to help heal it?

So it's not just about what you take out. That's why we should call it an addition diet.

It's an elimination diet. I know, I really, I am with you.

I think we should come up with a better name for it.

Yes, I don't like the elimination part. That's one thing. There are two things I really like to emphasize with my patients, and one is it's not just about what you can't eat. I know it's easy and it's very natural to see this list of foods, whether it's a short list or a comprehensive elimination diet where we have a ton of foods that we take out like corn, soy, wheat, gluten, dairy, all these things. And then they're left thinking, well, What can I eat? Well, the reality is there's a lot more you can eat than you can't eat in this situation. But it's so easy because food isn't just calories and fat and protein. It's also what connects us. It's part of the community and emotional connection we have. So if you're used to eating these foods all the time, it's a big shock to some people. So then that's all they can see, is what they can't eat.

But it's really... You're taking away my cheese.

I've got a story about that.

Wait.

Yeah, exactly. But it's also about what you can add in, not only in terms of whole foods that are rich in polyphenols, these things that protect and heal the lining of the gut, but it's like getting more diversity in your diet, learning how to get into the kitchen, cook with all these different flavors and textures, sort of like reconnect.

Spices.

With foods. Exactly. That are actively healing, but you're also enjoying this.

Yeah, I was joking about the, The artichoke, but that's a great prebiotic food. I eat them every week, multiple times a week.

Yes.

And it's so delicious. I dip them in extra virgin olive oil, balsamic vinegar, which also helps your gut. Exactly. Polyphenols. Right.

And so it's really fun.

It is. It can be fun.

And then you get to add stuff back, right?

Right.

So, that's so important. And that's what people don't realize. And a lot of people come to me and either they've already tried an elimination diet, let's say they've done gluten and dairy free, My first question always is, did you have any help? Did you do this on your own? Did you go online? Did you find something? Or did you have a professional who knows how to guide you through this? First question. Second question is, how do you reintroduce? What do you do? Well, you know, I went and had a pizza. I had a pizza.

Well, that's like, you know, three or.

Four different- All these things. And we're not even talking about good quality gluten. We're talking about white flour.

Right.

That I had this patient when she was, she had rheumatoid arthritis and she was overweight and she really was struggling. And, and she was, you know, tested gluten. She was definitely tested for gluten sensitivity, and she had elevated antibodies. And I said, you really can't be eating any gluten. And she's like, well, I'm not, I'm not, I'm not, I'm not. I'm like, well, let's do an experiment. Let's put you on a, at the point at that time was just a, we call it an ultra clear fast. So for 10 days, all she did was this rice protein shake, which is hypoallergenic, and that was it. All of her symptoms went away. She dropped a ton of weight and she realized that there was gluten in her diet and it was hidden. It could be in soy milk that you're having. It could be in all types of dressings and stuff that, and it's got all these names that you wouldn't even know.

It's like sugar.

And then in processed food, there's something called microbial transglutaminase. So gluten is what is often used to make things stick together because it's like glue, right?

Right.

If you ever made flour bread, it's like that sticky thing and it makes processed food stick together. And so they have bacteria make these actually bacterial versions of gluten essentially that then they put in food and it doesn't have have to be on the label. So pretty much if you're eating any package or processed food, you don't know what you're eating. And so I think, and people are really, really sensitive, even a fly by, you know, if they're eating out of a grill that somebody cooked something on was breaded. Cross-contamination. You're gonna get it. So I think, you know, I did that and then I saw her a few months later and I was like, what happened to you? She lost 40 pounds. She, like all of her symptoms went away. So I think people have to understand, like it's, you know, oh, I just had like a little bit.

And for some things that, you know, may not be a big deal, but if you have a little bit of gluten.

Even a thumbnail full in three months, you're back to square one.

Yeah, it's tough. And in terms of gluten, there are so many people, I'm sure you've had this experience too, where people will go over to Europe and have the gluten there and they won't react as much. And for some people, that is the case. For some people, they just have to keep it out entirely, no matter where they are. But I think there are two major reasons why. Number one, in this country we've hybridized and basically genetically modified wheat to have double the amount of gluten because of exactly what you're saying, that stickiness. We like the texture, we like it's just trying to make it more palatable.

You- don't want those giant- freezing to.

Our- croissants and bagels instead of the little ones. And then also we spray wheat with herbicides, pesticides, all these things and the combination of the excess gluten with all of these chemicals, just it's a perfect storm for our gut and leaky gut and dysbiosis and then all of the other symptoms that come from that. And that I think of joint pain, I think of headaches, I think of ADHD, I think of a lot of things that are associated with that sensitivity specifically.

Yeah, I mean the gluten story is really interesting because you know, it's like, you watch these movies like, hey, I'm gluten free.

It's like, what's that?

It's like, I don't know, but everybody's doing it. It must be good. Yep, all those, yep, I've seen them. Exactly. And it's sort of become this cultural meme.

And most people don't even know what.

Gluten is, but it's a protein that's in wheat that can be very inflammatory and the modern wheat has much more of these gluten proteins. And tell us why gluten is, of all foods, is so critical in terms of driving this leaky gut and leading not only to gluten sensitivity but to all these other sensitivities that sort of follow on, that are like hangers on to the gluten.

Exactly. Well, there's one thing that I will say in terms of when you eat gluten, that's one of the major drivers of something called zonulin. And zonulin was discovered and found to actually drive leaky gut. So to give signals to the lining of the gut to open up and make those gaps so that things fall through. So it actually is one of the major drivers of leaky gut for that reason. And as I said, so basically, this.

Is a natural molecule in our bodies. It's designed, you know, to take care of things. For example, if you get cholerasis, Sometimes it's good to have a leaky gut. Right, sometimes. But gluten tends to trigger this, according to Dr. Alessio Fasano, who's the world's expert in gluten at Harvard, that it triggers some degree of increase in zonulin in everybody, which can trigger some degree of leaky gut in everybody. Regardless of that. Now, some people do fine and they're okay with it and they're really healthy and it doesn't matter, but if you're looking to dramatically reduce inflammation, making gluten a staple in your diet is not a great idea, particularly modern wheat. So, if you want to eat ancient spelt or- Einkorn wheat or einkorn wheat or kernza wheat or certain rye, those might be better tolerated.

Belts, especially those that have been sourdough, where the traditional way of actually creating and making breads.

Actually, Dr. Fasano said, here we have these fast rising breads, one hour, boom, two hours. He said, In Europe, it's 12 hours, 18 hours, 24 hours, they make their bread rise. So it actually creates a very different process in the wheat that breaks down some of the gluten and creates less reactivity. So there's a lot of explanations.

Absolutely. So yeah, eventually, no matter who you are, and I think he said this, Dr. Sano said, Regardless of your predisposition to gluten sensitivity, celiac disease, if you have gluten in your diet long enough and in large enough quantities, You were gonna lose. It's the human that's gonna lose. It's the gluten that's gonna win.

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.