What's Driving Your IBS And Gut Issues?

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

Traditional medicine is naming and blaming. You name the disease and then you blame the name for the problem. Oh, I know why your stomach hurts. You have irritable bowel syndrome. No, that's just the name of the problem. Hey everyone, it's Dr. Mark here. This episode is sponsored by Butcher Box. You probably heard me talk about Butcher Box before because they've revolutionized the process of buying high quality meat and seafood. I love to cook and I have a super busy schedule, so whenever I can spend some time in the kitchen, I want to have all my favorite ingredients right at my fingertips. I'm also really picky about the quality of my meat and seafood and can't always find what I want, what I trust at my local markets. And that is why I love Butcher Box. They make it easy to get humanely raised meat and wild caught sustainable seafood by delivering it right to my doorstep. There are different box varieties to choose from along with different sizes and an easily customizable schedule for ongoing deliveries. Sometimes I realize I'll be out of town when my next order is due and it's easy to change my delivery date to when I need to. There's nothing quite like a good steak and ButcherBox 100% grass-fed, grass-finished ribeyes have become a new favorite for me. They're a perfect combination of juicy and tender with a rich flavor and they're so simple to prepare too. I love searing them with a savory spice blend and serving them with a huge arugula salad for a quick dinner. ButcherBox is committed to humanely raised animals that are never given antibiotics or added hormones and since they take out the middleman. They're actually surprisingly affordable. The average cost breaks down to about $6 a meal. There is a major stipulation I always tell my patients about when it comes to animal protein. Quality needs to be a priority. And with ButcherBox, you can feel good knowing you're getting the highest quality meat and seafood to optimize your diet. Right now, ButcherBox has a special offer for new members. If you sign up today, you'll get two ribeye steaks free in your first box by going to butcherbox.com forward slash farmc. That's with an F, F-A-R-M-A-C-Y. That's 200% grass-fed ribeyes by going to ButcherBox.com www.box.com forward slash pharmacy. If you're like me, you could probably use a little extra nutritional boost in your day. Even if you're eating a whole foods diet, it's super hard to address all of the nutritional gaps because of our poor soils that the crops grow in and just the general stressors and toxins we encounter in our day-to-day lives. And that's where ag1 from athletic greens comes in. Their incredible supplement has 75 different nutrients that work together to fill out the gaps in our diet. I take one ag1 every day, and I've noticed then I consistently feel better and have more energy throughout the day. Plus it works with any keto diet, any paleo diet, vegan, dairy free, even gluten free. I love this product because it's like investing in an all-in-one nutritional insurance plan. And it's not just me, professional athletes and health experts recommend AG1 too. I hope you'll choose to join me in boosting your vitality by trying AG1. Right now, they are gonna give you 10 free travel plaques with your first purchase. All you have to do is visit athleticgreens.com/hymen. Again, that's athleticgreens.com/hymen. Now let's get back to this week's episode of the Doctor's Pharmacy.

Hi, this is Lauren Fein, one of the producers of the Doctor's Pharmacy podcast. IBS, or irritable bowel syndrome, is a common gut problem that affects millions, resulting in miserable, often debilitating symptoms like bloating, cramps, diarrhea, constipation and pain. IBS can be caused by a range of factors, which is why it's so important to personalize treatment based on the unique circumstances that exist for each person. In today's episode, we feature three conversations from the Doctor's Pharmacy on the range of factors behind irritable bowel syndrome and how to resolve this condition. Dr. Hyman speaks with Dr. Tod Lopatin on the various root causes of IBS, with Dr. Emeran Mayer on the role of the microbiome when it comes to gut health, and with Dr. George Papam:.

On when parasites are the cause of IBS. Let's jump in. so let's talk about this thing called irritable bowel syndrome. What did we learn about it in medical school?

Not much. I mean, we basically learned that it was one of those conditions where you sort of treat the patient and it's not serious, you're not gonna die from it. And I can remember actually at Dartmouth, we had Dr. Almi and he was an expert in irritable bowel. And back then it was felt to be more of a sort of neurologics or like stress related things. Psycho-emotional. Psycho-emotional, and actually, I'll tell you, this is an interesting side story. He did a test where he took some medical students and was measuring the manometry of them. And while he was doing the sigmoidoscopy, he was measuring the tension in the colon. And then he, while doing the, you can only do this to medical students, and this is back in the 50s, and he told them, he goes, I think I see cancer. All of a sudden, there was a spasm of the colon.

Oh, yeah.

And it was, and it was like he wanted to evoke to see what it was, what was going on with the irritable bowel. And they thought it was a lot of us were nervous related, and which there is a, there's a stress component. And so back then, the concept of irritable bowel was that it was all.

Sort of in your head. It's all sort of like, we had a very fancy word for it in medical school. We called it supratentorial, which is a doctor's way of saying it's all in your head. It's all in your head. The tentorium is that thing that kind of separates your top of your brain from the lower brain. It was a joke, but it was very pejorative. And we often thought that these patients were belligerents. It was called functional bowel disease.

Yeah, he's a lot of bugs.

There was no real cause for it. It was more psychological. Yeah. And maybe stress related. And these people are all emotional and upset. Turns out it's not so. Right.

And we.

And we call it syndrome. Right. Syndrome.

So what. When we say syndrome in medicine, what do we mean? It's a constellation of various symptoms. And, you know, we. We now. We don't know what the hell's going on. We don't know what. It's like. Yeah, it's like. It's like, you know, chronic fatigue syndrome. you know, it's like, you know, how many different things can cause chronic fatigue? It's like there's 23 flavors or how.

Many flavors of Baskin-Robbins ice cream? Same thing with your 31.

I used to scoop Baskin-Robbins ice cream. That's one of my jobs. Right, right. And then probably cause irritable bowel. Probably with all those artificial flavorings and sugar. So yeah. So, and you know, nowadays we sort of classify irritable bowel into irritable bowel with constipation, irritable bowel with diarrhea, and then mixed irritable bowel. That's how we're sort of, putting an ICD-10 code on it. And that's a way of conceptualizing it. But there are lots of different things that play a role. Without question, I think stress does play a role with irritable bowel. And I think that stress can manifest in the body in so many different ways. We've talked about this when we talked about autoimmune conditions because oftentimes when we have a patient and some stressful event happens, it triggers a host of things and sort of like a or ripple effect that goes on in the body. And without question, there is a stress component to some irritable bowel. Well, yeah.

I mean, you've got your second brain in your gut. Exactly. There's more serotonin in your gut than in your brain. You've got this whole nervous system that connects the two that is extraordinary complex and feeds back both ways. So from the top down and bottom up.

So irritable bowel can cause irritable brain and irritable bowel goes back and forth.

Right.

And you want to have a happy bowel, a happy brain. That's, you know, that's really. Sounds like the key to a happy life. Happy bowel's happy brain. Exactly. Exactly. and then, yeah, and there is that, it's an interesting thing that you talk about because you have that gut-brain connection and it's like a two-way highway and they're basically communicating, the brain's talking to the gut and the gut's talking to the brain. And then you also have the enteric nervous system and some people sort of forget about the enteric nervous system and that's the intrinsic nervous system to the gut. So literally, if you sever the spinal column and there is no connection to the gut and the brain, the gut still works. You can still, you know, poop, Fine, if you sever the spinal cord.

It's got a mind of its own.

That'S what you're saying.

It's got a mind of its own, exactly. Right. But Todd, I want to come back to what you said, which is really important. You said, we categorize irritable bowel as with constipation or diarrhea or whatever, and there's a whole classification system that is driven off of symptoms. And the difference between functional medicine and conventional medicine thinking about any disease is that it's not focused on the symptoms, It's focused on the causes. So just saying people have irritable bowel doesn't tell you anything about the cause. It tells you they feel uncomfortable, they're bloated, they have diarrhea, their bowels are weird, they're uncomfortable, cramping, whatever the symptoms are, is irrelevant when it comes to trying to figure out the cause. I mean, yeah, okay, you have irritable bowel, but that's when you start to think about the problem. In traditional medicine, you name the disease, you stop thinking. You know, and our colleague, Sid Baker, always, had this great term. He says, you know, traditional medicine is naming and blaming. You name the disease and you blame the name for the problem. Oh, I know why your stomach hurts. You have irritable bowel syndrome. No, that's just the name of the problem. Exactly.

But.

But he talks about thinking and linking, which is functional medicine, right? Yeah. You think about the problem and the cause once you get the diagnosis and you link everything together to see what the factors are. And there's no such thing as irritable bowel syndrome. There's. You know, about syndromes, like you said, there's 31 flavors and each one is different and each one needs to be treated differently.

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

So typically go to the doctor and you have your little bowel, what do they tell you to do?

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

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

Yeah, that's, that's, learn to live with it. And that's essentially what they're dealing with stress. Yeah, that deal with stress. Yeah. And they'll, the interesting thing, this is, I had a patient just the other day who I was seeing for GI symptoms. It wasn't specifically IBS, but the patient's GI doctor said, diet has nothing to do with your symptoms. I mean, it was unbelievable that a GI doctor told her diet makes no difference. I couldn't believe it. I just, I like- actually, I was.

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

Right?

And that's the difference in functional medicine. Yeah, exactly. Yeah, it's sort of, it's a little bit mind blowing. And yeah, you know, you talk about like, you know, with going back to Sid Baker and sort of name it.

And claim it kind of a thing. Blame it.

Yeah, name it, name it, blame it. Is that, you know, and then tame it with a drug.

Right.

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

I love that.

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

Next, next patient. That's it. That's it. So, you know, doctor sees you, you.

Have irritable bowel, they give you metamucil. What else can they do sometimes? Well, sometimes they'll give prescription medications. I think one of the older ones that they used to do for I guess was Zelnorm. Remember that one? Yeah. They took it off the market 'cause it was like really hurting people.

I think people were getting- Librium was the other one. Remember that?

That was like a Valium, which is basically taking Valium. Is it Valium for the gut? Yeah, Valium. And they're actually, in certain patients, there were some benefits from that 'cause it did sort of calm down the nervous system, I think.

Sure, anybody taking Valium?

You're gonna feel good.

A couple of shots of akila, a little Librium.

I feel good.

Right.

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

Right.

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

And I think the big thing is time, taking the time to talk to a patient. And, you know, what?

Talk to a patient.

Actually, and listen to the patient.

Wow, listen to the patient.

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

Yeah, no, actually there was a study published years ago in JAMA. It was 18 seconds.

18 seconds.

20 seconds before the doctor interrupts.

Exactly, 'cause we're trained to probe the questions and they have their own path of thinking going down that. But I think the big thing is, you know, we spend a lot of time listening to the patients and getting a history and a story. And, you know, an important thing is an interesting thing in terms of IBS patients is that babies who have colic and they've actually looked at what is it that causes colic in babies? You know, the latest evidence is that babies that have colic have high levels of Klebsiella. Klebsiella is a bacteria. And we know that Klebsiella is actually associated with other inflammatory conditions and autoimmune conditions. So Klebsiella excess in the gut is actually associated with ankylosing spondylitis, which is inflammatory bowel disease, which manifests systemically with arthritic symptoms. So getting a history of colic is important. Listening to the history of, you know, were they vaginally birthed? Were they breastfed? What type of diet did they have as a kid?

And when did they get food introduced?

Yeah.

Yeah.

And all those things can play a.

Role in terms of, like, early gluten.

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

I think it's very, very different what you're saying. This approach really is being a medical detective. Absolutely. And it is relevant whether you're breastfed or, for example, or vaginally birthed because that affects your gut flora and the development for your whole life. I recently read a study that showed bottle-fed babies have a high levels of a, what we call a short-chain fat, which is made by the good bacteria. This one is called propionic acid. Now, this is not such a good one and it's been shown to induce autism in animal studies and has been associated with autism and ADD, that is increased when you're bottle feeding. When you breastfeed, you get increase in butyrate, which is the beneficial short-chain fat that actually heals the gut and reduces inflammation. There's all sorts of good things. So we think, oh, it's the difference bottle-fed breastfed. That's not to make people feel guilty if they have to bottle feed. You have to do it sometimes, but you can fix that by making sure they have the right prebiotics and the right probiotics. Because breast milk has undigestible fibers that are prebiotics and sugars that are prebiotics.

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

Yeah.

Yeah. So powerful. And so we dig down into the story and figure out when did it.

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

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

So a bunch of people there will about have SIBO or bad bugs growing where they shouldn't be in the small intestine.

Exactly.

Yeah.

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

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

Right. Because what's happening is, is the, you know, there's, we have bacteria on our skin, we have bacteria. bacteria in our mouth, we have bacteria in our stomach, the small intestine, large intestine, most of them sort of live in the colon. But there are times when the colonic bacteria start migrating upwards and they go higher up and it's sort of like, you know, invading a neighborhood. That's, you know, and they start- It's mostly sterile up there. Yeah, it's, I think not necessarily that we always thought it was sterile, even the stomach has bacteria in it. But it's just much less and there are all different kinds of bacteria. So the lower bacteria are more fermenters. They ferment things. And that's where we get, I think I have talked about that. And I've seen this a couple of times, the auto-brewery syndrome where patients, in fact, I just recently had a patient, a fantastic case, and he actually heard me on one of the podcasts where I was talking about auto-brewery syndrome. So I did a consult with him and he ended up going and buying a breathalyzer. And he confirmed that he has auto-brewery.

Syndrome because he was producing alcohol.

He was driving over the limit. He was just short of the limit.

Saves you money on beer for sure.

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

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

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

People don't realize it, but cows just don't produce methane. Humans can produce methane if you have this. And we measure that coming out in your breath. We measure hydrogen. We have to take this drink. And that's really a clue that there.

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

Up more hydrochloric acid.

Like clogging a dead horse. Exactly. Yeah, absolutely. And I would, I would venture to say that most people's issues are not.

High acid in the stomach. It's low acid. Yeah, it's low acid. And we're taking more of these acid.

Blockers, which, by the way, also cause irritable bowel. So they help your heartburn, but they cause trouble. And now there are, there is a role for short-term use of these, these acid blockers, like in the ICU. The studies have been shown they've been very helpful to prevent stress induced ulcers and hospital acquired pneumonia, but they're really to be used short term. And when you start using them long term, they are very toxic. They are very toxic. They produce increased intestinal permeability. They cause malabsorption of nutrients, vitamin B12, iron, other trace minerals.

Zinc, yeah.

And they cause bacterial overgrowth.

And they cause osteoporosis and.

Oh, yeah.

Huge, huge, huge.

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

You know, I remember, I've talked about this before, but I remember when I was in medical school, the rep, these just came out and the drug rep was like, these are super powerful drugs. You never want to give them more than six weeks. They're designed to treat ulcers. After six weeks, you gotta stop 'em. Don't take 'em long term. And now people eat 'em like candy all day long, every day. And I'm like, this is not good. And we see so many complications from that. So if your irritable bowel is there and you have these acid blockers that you're taking, there might be a correlation. So we talked about SIBO. and we can talk about how to treat that, but essentially it's killing the bad bugs and reseeding the gut. And what other things are driving your bowel besides that?

Well, also you can also potentially have problems with part of the intestine that causes peristalsis. So normally you think of the gut as like this conveyor belt that's always moving things through. So you eat and within about 24 hours everything should sort of move through. And there are some patients, especially with the patients who have problems with constipation that will have problems with motility, really motility disorders. And, there's a test. It's not moving down.

Not moving down.

And, there's a part of the intestines which is called the migrating motor complex. And, you can actually test for antibodies against the migrating motor complex. It's called IBS-SURE test.

And, I'll do that in some time.

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

So, so that is a very important point because, you know, there are the typical things that go on. Food sensitivity, gluten, Dairy. Some people react to the chemicals in food that are food additives, food colorings, food colorings, sugar alcohols, people emulsifiers, emulsifiers, all these things that are in our junk and processed food do have a huge impact on people. There's obviously the SIBO. so many people get parasites. Yeah, we, little, little microscopic hitchhikers. Yeah. And there's, there's one called blastocystis, which is really common. It doesn't, it doesn't cause a horrible.

Disease, but it can cause you're going to bow in about 30% of people that IBS. Oh, yeah. I, I want to venture to say that I have picked up a lot of these. I call them little microscopic hitchhikers. And when you actually look in the, in the mainstream literature, they, you know, they basically say that, you know, a lot of these, you don't need to treat it. So there are times when somebody can, you know, they have died to me, but histolytica and blastocystis and sometimes endolimax. and sometimes people will have these and they'll have a small amount of them and they may not cause any symptoms whatsoever. But if I find them in the stool test and patients are having symptoms, I treat them.

Yeah, absolutely. And then there's also other things. People have like enzyme deficiencies we can see on stool tests. They're not digesting their food well. And also, for me, I had terrible irritable bowel, almost 30 years ago. It was from mercury poisoning because mercury affects all your enzymes. It basically interrupts the enzyme function. of many different enzymes throughout your body, including your gut. And until I got rid of the mercury, my irritable bowel wouldn't go away no matter what I did. Yeah, I just ate turkey and broccoli.

And brown rice for six months and nothing worked.

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

Exactly, yeah. And it's personalized. It really is. It's totally personalized and it takes time to figure that out.

Yeah. So, diet plays a huge role in regulating what bugs are growing or not growing and how they affect everything from our mood to our weight. and our cognitive function. But it was fascinating is that the other direction also affects us. In other words, our thoughts and feelings and emotions and stress actually create a feedback loop to the gut. It can actually cause damage to the gut, alter the bacteria, create a leaky gut, create inflammation. It actually is almost the same as eating a bad diet. Can you explain that?

Yeah, so this is the intriguing thing. So you asked me earlier, you know, why are we why? I mean, how do we end up where we are today? One is the diet, but the other one is the top-down influence of, of our minds and our chronically stressed brains. Our brains did not develop for that. So we developed very effective acute stress response systems that saved us human species, you know, from Extinction many times. But these systems are not designed as adapted for chronic ongoing stress, which we experience obviously this the last year. We've seen the impact of that on people's lives. And the chronic stress will not go away now that the pandemic will be ending. There's enough other factors. So what the brain does, and I like to call it the brain-gut-microbiome system rather than an axis, because it is a bi-directional system, brain talking to the gut, talking back to the brain.

And.

The signals that the brain sends via the sympathetic nervous system can talk directly to the microbes and make them more aggressive, changes their gene expression patterns and the way they interact with us as the host. But they also indirectly change the microbial abundances by changing the peristalsis and the motility and the transit, the secretion of fluids into the gut. So when you stress, your microbes live in a totally different world. Right. And if you're in a relaxed state. And what is known repeatedly, you know, long before the diet-related leaky gut syndrome came, you know, appeared, is that both severe acute stress and chronic stress can increase the permeability of the gut, decrease the mucus layer, and lead to a low-grade immune activation at the gut level. So now imagine in our world an unhealthy diet that does exactly the same thing together with the sprouting plants. It's It's the worst thing that we can do to our gut health. And since gut health doesn't spin, you know, it goes very well. So, I think that's really that.

Yeah, I think that's so key. I mean, everything we do affects this inner garden. And we just thought it was just inert waste material that now we're recognizing is regulating almost everything in our body and that the key to health and longevity is to optimize our inner garden and to figure out how to do that. And the fascinating thing to me was when I saw in my practice, and this was decades ago, how the gut microbiome, we didn't even have the word microbiome back then, but the gut flora affected the cognitive, emotional functioning of my patients. And I have story after story of cases of, you know, ADD or behavioral problems or depression or neurodegenerative diseases. When you fix the gut, which we did as sort of a matter of course in functional medicine to address physical problems that the mental or cognitive problems would get better. And sometimes in striking ways. And we wouldn't be able to measure the imbalances in various flora or the overgrowth of certain bacteria, the overgrowth of fungal components, and how those had huge implications for their cognitive function. And by treating them, people would get better. So what are you seeing in terms of the therapeutic strategies we need to be using now for chronic disease? Because when you go to the cardiologist, or you go to the rheumatologist or you go to the psychiatrist. They're not saying, can I please have a stool sample? I want to analyze your microbiome and tell you what you need to do to make it right. They're like giving you the regular medication for their particular disease. How do we get past that hump in medicine and start to really have doctors and the system as a whole start to take this into account? And, and, and how, and what are these ways in which the microbiome specifically is affecting the brain?

You mentioned tryptophan, but I think there are others. Yeah, I mean, there's many other of these so-called neuroactive metabolites, for example, you know, they're being generated by the microbes.

And.

The relative abundances of this, it's a combinatorial system. The relative abundances of these microbes determine ultimately what the output to the brain or to, you know, I mean, it's not only the brain, it's other organs as well, but Having been interested in IBS for a long part of my career, now this has expanded to cognitive decline and to psychiatric disorders. I've seen the same thing as you do. And I have to say the experience that I had being in the middle of the conventional medicine world at a university was ignorance and total rejection at meetings or so the whole brain system was something that people either were not interested in or put away as psychological, hysterical stuff. I have a quote from a very prominent colleague who called this the disease of neurotic housewives.

Irritable bowel, you mean? yeah.

So that's what we learned in medical school.

It was just people who had anxious and crazy, and it wasn't really because of anything physical. It was functional. But it turns out we were just not very good at looking. Right. So it's like saying, well, you know, like, we won't be able to see bacteria until we had a microscoped. Right. So now we have a different kind.

Of lens to look at all these.

Conditions, and we see these connections that we didn't before. But the, you know, I, I think I, I give, I give you and functional medicine a lot of credit here because The emergence of that type of medicine, I'm not that I agree with everything, you know, being skeptical scientist, I.

Still have some- I don't agree with everything either.

If I can't with a certain area. But on the other hand, I think it has another tremendous influence because all of our patients have already been to a functional medicine doctor, you know, and they come with these concepts. if we are open-minded at a university, you would actually learn a lot. So, for example, the leaky gut I learned from my patients, learned it from physicians like yourself long before this became an accepted term. So, I think that the system will gradually change. I mean, it's now, like at UCLA or other places, like GI wellness programs that deal with, you know, relaxation, mindfulness-based stress reduction, diet, sleep. So they really look at the whole, at the whole human being rather than just the organ or the, you know, the ulcer or whatever. In Psychiatry, I think you will be slower. I think most psychiatrists are still very skeptical that this plays a big role. and we, I think we need to find, we need to get examples of, and unfortunately this will take well controlled, randomized controlled studies to convince, you know, much of the medical world that this is actually happening. I, I can just, I mean, I can already hear it now. People say, oh, there was all this excitement, like when you wrote your book about the, the Mind God connection, but I haven't heard anything about this. is that really true or was this just a fad?

Yeah, no.

So there's still this skepticism by.

The.

Traditional medical establishment that this is not something important. We should also keep in mind, many of the medications that are being used, for example, in psychiatry are also metabolized by the microbes. So what we ultimately, what our brain sees is, to a large degree influenced by what the microbes do with it. And that again determines, is determined by what microbes you have and what diet you're on. So, you know, it's this link. I think what's going to be easier, and I see that Trend already, there's a field now called nutritional Psychiatry that is gaining ground and. I think it's going to be easier through the dietary path. And as physicians are being trained in this, whereas I had maybe one hour of education in nutrition in my career.

It's not much better now.

But I think this, yeah, it's not much better now. But I think this will be changing. I've seen trends that just go in this direction. Younger physicians, they come to us and do research with us in our center. they're extremely interested in that and really want to pursue those kind of avenues. But I mean, I should say another thing, you know, what will slow this process, you make a lot more money with the traditional, with the conventional medicine, with the procedures. And so for example, as a gastroenterologist, so we now know that, you know, people get colon cancer earlier at an earlier age. And so the way the medical system has responded to this, so let's move colon cancer screening guidelines to start at 40 instead of 50. So probably in 10 years, we're going to move it to 30 years of age. And when somebody gave a lecture about this a few years ago in, in our division, I was asking, you guys do any dietary assessment or this people that developed colon cancer at age 40 and said, well, that's actually a good idea. We should, we should look into this. I mean, what a concept.

It was just, it was amazing to me.

But that shows, what a concept.

Yeah.

When you think about it, you put.

Pounds of, but you make more money doing colon cancer. Right? Yeah.

That's true.

You make more money. But you put pounds of food in your gut every day. How do gastroenterologists not think that food has anything to do with digestive disorders? It's just, it's amazing to me, actually. oh, you need more fiber if you're constipated or, you know, avoid these Foods if you have reflux, but it's very limited and superficial. So. So if you had patients coming to you with mood disorders or neurodegenerative disorders, how would you approach treating them through the gut?

Yeah.

So I, first of all, I start to explain to them this concept of the brain gut microbiome system and how it's influenced by both the brain and. And the gut and the diet. I present them with a very holistic model of treatment that we want to target all the parts of the Sprinkas microbiome system at the same time that I don't think a single approach, just limiting to diet will be sufficient. So there's, you know, the regular moderate exercise. I mean, like all the things that we know are beneficial, looking at your sleep, stress reduction, I, with depression, it depends on the amount of anxiety and depression that's actually there. I almost always, now that we have these simpler versions, for example, of cognitive behavioral therapy, the online systems that are coming, you know, rapidly becoming available, anybody can do from their home in 10 sessions. So I recommend all these things plus the diet. and from a dietary standpoint.

I mean.

Obviously this is a minefield, you know, as you know better than anybody else. Sure. I've come to this conclusion and pushes in my book that if you eat the things that are best for the health of your microbial system, you will automatically do the best for your health and for preventing or slowing cognitive decline and, you know, treating your depression. Depression, if you have a severe form of major depressive disorder, I don't think diet alone will do it. I think you will have to combine it with medication, at least initially. And then as a, if you get into remission, it's a maintenance. You can rely on your diet part.

Yeah.

But I always look at this, you know, these multiple channels that we have to access the brain-gut microbiome axis. So, so this diet, you know, yeah, the microbiome targeted diet makes it easy. You don't have to, you know, you don't have to argue how many grams of protein are best for you and how many grams of, you know, carbs, what percentage, I think it becomes very simple, you know, Microbes love complex carbohydrates that they break down into health promoting molecules such as short chain fatty acids. So it's a very simple. So I don't know how this is going to be perceived that recommendation once a book comes out, but I certainly have thought about this a lot. And you know, could get a philosophical twist to that as well, that microbes are the most abundant and ancient life form on this planet. So they know exactly what's best for the planet and the creatures that live in it. So providing them with the healthiest food will take care of us too, and the environment, you know, as we know from a largely plant-based diet being beneficial for environmental reasons.

So, I want to just sort of summarize a little bit here because what you're saying essentially is that we can treat a whole host of chronic diseases that are in origin inflammatory, including all the brain diseases, including depression, which is inflammatory as autism and ADD and Alzheimer's. These are all brain inflammation diseases. so what you're saying is we can alter the course of these conditions by changing our microbiome. And then a lot of it has to do with our diet, with exercise, stress reduction, sleep, and maybe some other things that we haven't really talked about, such as whether there's probiotics or prebiotics or things that can help fix the gut. So talk about how we sort of need to sort of eat differently, specifically for the microbiome. You mentioned plant, I like to call it plant rich diet. But how do we design a way of eating that facilitates a similar kind of microbiome, for example, as the hunter gathers? We all need to be paleo, as we call it, or what should we be doing?

Yeah, I would say, you know, I mean, I stay away from these categories like paleo or keto or, because I think it's that they're so contaminated by political and personal, strong personal feelings that, you know, I actually want to get a blurb from a book from a prominent person in this diet field. And he didn't like that in my book, there was one sentence about eating fish and chicken. And he said he cannot write a blurb for a book if it has that sentence if I would change it. And I said, I'm not going to change it. But this is the kind of world I think that we have gotten into that people are so fanatic about certain types of diets. So I would say, I mean, the things you want to do is you want to create as many different microbes or nurture as many different microbes as possible. And since they're all specialized in different types of fibers and different types of polyphenols, the greater variety of the food, the more we force the system to diversify. And that's really the whole goal in it. And then continuing this, this doesn't help just to do it once. You have to really change your lifestyle. This has to become a permanent way of eating. Then you nurture the richness and the abundance of this expanded ecosystem. We know we can't go back to the ones of the hunter-gatherers or some people, the hot spot in East Africa, because some of them, sadly, some of these microbes have actually disappeared or extinct, just like, you know, we can't bring back, you know, the animals that have gone extinct, even though, yeah, genetic engineering, CRISPR may make that possible again. But, so we can't, but we can bring back about, I think we can reach about 80% of that, these kind of systems if we stick to a diet like this. And I would say in addition to the variety, different types of fiber, plants, fruits and vegetables, it's also external microbes. So you mentioned probiotics. I personally would recommend if you have access to natural. And if you like the taste of natural probiotics and fermented vegetable or dairy products, go with that. If you don't have access, you know, take, take a supplement, which is often a challenge because there's not enough controlled trials that would actually show you this one is better than this one, you know, and. so the way people have dealt with it, you mix a whole bunch of them together in very high concentrations. We don't know if that mix is actually better than if you had a couple, you know, that make the big difference. But if you look at countries like Korea, you know, that consume a vast amount of fermented products from infancy on, I would love to do a study on these chronic diseases. if there's actually an impact on that. Well, this study has not happened so far, to my knowledge. But this is what I would recommend, you know.

Yeah.

And there's, there's also one thing that, you know, I think it's really important to mention. It's not just what we eat, but also when we eat it. So there's always three things that I think, what we eat, when we eat it, and where does it come from? those are the three main theory I think you should make. So when we eat, as you know, and as the audience knows, there's a lot of these intermittent fasting strategies, beautiful results in animal models, me being the big skeptic of animal models from my own personal negative experience. You know, the human studies are not as convincing. because they're more difficult to do. They have started now randomized control trials. Of all these strategies, I personally like the time restricted eating because I think it's the most realistic. There's studies now on the microbiome that actually that positively affects the microbiomes that, you know, mice that are on time restricted eating can actually eat what's called a cafeteria diet, a very unhealthy diet. without developing metabolic syndrome.

So just, but it works better when you eat healthy though. I've seen those things.

Yeah, it definitely works better. Yeah. So, and this goes sort of into this whole concept of the keto diet. So you're in a ketogenic state for 18, for 16 hours. If your first meal of the day is at noon time and it's without any carbs and sugar, you can extend this ketogenic period even longer. And so you get multiple benefits. And so we have started this during the pandemic in our family and actually works really well. It's feasible. It's not, I'm not sure if I could fast two days a week on a regular basis, even if I wanted to do it. But the time restricted eating, I think, is something. So combining that kind of microbiome targeted diet largely plant-based with the compression of the time when you eat it, I think right now, in my opinion, is sort of the optimal way of influencing your metabolic health.

Yeah.

And in your book, the Gut-Immune Connection, how understanding why we're sick can help us regain our health, you talk about something called a gut microbiome diet, which is rather than focusing on, you know, the traditional macro micronutrients. You're talking about how do we eat holistically in a way that feeds our inner garden. And that's a very different Paradigm. And, and really in functional medicine, the way we start almost all our patients is by getting their gut right. And we try to do that through food and through the right lifestyle factors, supplements, sometimes resetting their gut through cleaning out the bad bugs. But it's an interesting idea that we have a, if we focus on a way of eating that facilitates a healthy microbiome, we can address a whole host of downstream chronic inflammatory diseases.

Which is in some ways, I mean, it sounds simplistic. It almost sounds like the string theory of chronic diseases. But I've spent a lot of time thinking about this and I think it makes a lot of sense. Now, the unfortunate thing is not everybody can do this. We haven't talked about this. We've seen COVID epidemic, the racial and socioeconomic disparities, that a lot of people don't have access to that diet or it's a lot more expensive than buying the hamburgers, two for one hamburgers for $2.50, which is completely ridiculous. that unfortunately becomes the diet of a lot of people that can't afford the other one. They certainly don't have the money to buy supplements. So this is a whole other question, you know, and unfortunately it's this part of the population that is most severely affected by these chronic diseases, you know, and COVID as well. So how to deal with that issue is another, it's a whole other challenge.

You know, we, we often are very sort of human Centric in our thinking. And, and what you bring up in the book is a different way of thinking about a relationship to our environment, that our own microbiome is connected to the microbiome of the soil, that what we eat, how we grow our food, how that impacts the environment, how that affects the planet, all are related and that we can't treat one without the other. And a lot of the podcasts I've had in the work I've done in my food fix book has really been focusing on the bigger ecosystem. of our food system and how it's creating the food that we're eating in a way that's damaging the soil microbiome, that's damaging our own microbiome. I mean, even glyphosate, which we use, for example, in massive amounts and which we have discussed on this podcast, destroys the microbiome of the soil and our own microbiome. And it's prevalent. It's on everything. So can help us connect the dots between the soil microbiome, our microbiome, and the overall health of plant and the planet.

Yeah, I mean, I should say, you know, one insight I also gained is the interactions of our gut microbiome with our gut is in many ways very similar to the interactions of the soil microbiome with the root system, the rhizosphere of the plants, all the way down to some very amazing details, you know, that plants secrete carbohydrate rich sugar like molecules in their root system when they're in trouble, which attracts the microbes to gobble down, you know, the liver of this, just like in our gut, you know, there's micros living that can live off the, off the mucus layer, which is also a carbohydrate, a sugar layer, you know, and just that, that, that concept that plants Depend on the microbiome for many functions on the soil microbiome, but many to defend against disease and stress. UV light, drought, pests, insects, a whole range of diseases. The plants sent down these distress molecules through their root system and attract the microbes from the environment that then form very close interactions and stimulate the plant to produce polyphenols, these same molecules that we now know are so healthy for us. And then these polyphenols go back up in the plant to the leaves and to the seeds and to the fruit to protect those assets of the plant. I just find it absolutely amazing that these same molecules that the microbes stimulate in the plants to help the plant.

Health.

Are re-ingesting and we're depending on the microbes to break them down into smaller molecules that can then do the same thing in our system. They can be absorbed and go to our distressed organs, including the brain.

And.

It'S beautiful how nature has done that. It's a design principle, I think, that works so well for the plants that evolution decided, let's stick with it. It works for humans as well.

Earbowl is so prevalent and it's such a big problem for people. And there's many causes of it, but sometimes it is a parasite. I had a patient recently who was a very famous lady and she was really struggling with chronic gut issues. And we treated her parasite and boom, she was instantly better.

Yeah.

So, again, Blastocystis hominis, which is a parasite, and another one called Entamoeba histolytica, they've both been implicated in IBS as triggers for IBS. Cerebral valve, yeah. So, if you can't find a reason for somebody's IBS and you should be looking for one, IBS is just not the diagnosis. There's a trigger for it. You should, you know, and you haven't been able to get to the bottom of it, you should be looking for those two parasites. Unbelievable. So, we're treating, so we're treating you know, I will start with herbal therapies and then I will advance to using pharmaceutical agents if necessary. But then I want to make sure the rest of their gut is working. So we look at their digestive processes and oftentimes why do we have the parasite? Because their digestive processes aren't working well. They're not making enough HCL in their stomach because they're under chronic stress. They might not be producing enough pancreatic enzymes. They may have some issues with their gallbladder that's limiting or and their liver that is limiting their production of bile or release of bile. So we want to make sure they have all their digestive enzymes, want to make sure that their gut immune system is working well. So we want to create that environment. So besides treating, I'm going to want to make sure that they're getting the types of foods and supplements in their diet that will support a healthy gut microbiome. Good prebiotic foods, the cruciferous vegetables, I want them to make sure they're getting things like broccoli and asparagus and Brussels sprouts and dandelions. My dad was Greek and we lived in a suburban community and in the springtime my dad would go around the yard and he'd get all the dandelions and he'd bring them in the house and he'd steam them up and boil them and he mixed them up with garlic and oregano and garlic and oregano and dandelions, right? What are we doing? We're giving our gut great prebiotics to feed the good bacteria and giving natural herbs and botanicals to make sure that we keep a healthy gut microbiome. So dandelion's really good, artichoke's really good, conjack root with glucomannan is really good prebiotic. so I want to not just treat the organism, I want to create a really healthy gut microbiome that has a healthy immune system that will prevent further disease down the road. Yeah, so really it's about not only.

Killing the bug, because I've been in traditional medicine, we were like, Kill it. Kill the bug.

Okay, carpet bomb it and let's move on.

Forget it. And the problem is that most people's gut don't get back to normal on their own. And I often see this even with celiac patients, they will people be told, oh, you have celiac, don't eat gluten, but they still struggle for years with all kinds of digestive issues that they cannot handle certain foods or they have bloating or gas. And it's even after they've eliminated gluten. So you really have to go through this whole gut restoration program. We've talked a lot about on the podcast, but it's such a key part of functional medicine, this five-hour program where we get rid of the bad stuff, foods, bugs, whatever. and then we kind of put in the good stuff and help the body kind of repair and heal. Yeah. So that's really an incredible approach. And we've seen patient after patient have had amazing. And I've seen, I've, I've come across really crazy things. I've seen people with schistosomiasis from Africa, and I've seen people with endomyositis and I've seen a lot of parasites. Blastocystis is one of the most common ones. Yeah. And it's often thought to be not a pathogenic one, so it's not bad.

Yeah.

But it often does cause symptoms. And if people have symptoms and they bless this system and the invertible bowel. So let's sort of jump to this final topic because I think that it's.

Such an interesting topic.

Right. And it has to do with worms. Yeah. So, like, look, we all co-evolve with living with all these bugs.

Yeah.

And we had them and they live with us. What's interesting is that, you know, in the advent of sort of modern civilization, we've become over-sanitized and we've lost the contact with the natural world. And I, you know, I think we've seen this uptick in allergies in asthma, in autoimmune diseases, in inflammatory diseases.

MS, rheumatoid arthritis, psoriatic arthritis, and all these diseases.

And the question is why? Because when you go to the developing world, you go to a hunter-gatherer culture, they don't have them. There's just no allergies, no asthma. And I was seeing by the other day, I grew up every summer spending three months on a ranch with horses and poop and outside and being dirty all the time, dirt and sleeping in a tent. and, you know, like, being outside and I don't have a single allergy or anything. And I think, you know, there's this whole phenomena where you see what the kids who grew up on farms don't get allergies and autoimmunity.

Oh, my. I mean, if mothers today saw what you and I were doing when we were kids, mucking around in Creeks, holding on to salamanders.

Yeah.

You know, feeding, you know, we had a horse farm near us, and, you know, I would feed the horses, you know, apples through the fence, and they're licking my hand and, yeah, Mother's Day would be like freaked.

Right, exactly. So, we've sort of over-sanitized ourselves and there's a number of books like the Epidemic of Absence you mentioned, it really talks about this. And, there's a really good science behind using worms, reintroducing worms into the body. And, when you look at the part of the immune system that has us deal with worms, It's the same part of the immune system that helps us deal with allergy or asthma, which is fascinating to me because it's like, oh, it has nothing better to do because it's supposed to be fighting the worms all the time and keeping everything under control. But if you don't have the worms to fight, all of a sudden the directin gets turned on you and your body starts dealing with attacking.

Exactly.

Becoming more allergic or autoimmune. related.

So there's an interesting observation. There's an observational study that looked at people with autoimmune diseases in Sub-Saharan Africa and in underdeveloped countries. And they looked at those in regards to the severity of disease, progression of disease, and response to treatment compared to developed countries like the US. And they found that those patients in sub-Saharan and they compared it along the lines of the load of parasites. And they found that the patients in sub-Saharan Africa and the hypothesis is that it's because of the parasites, they have their disease, their rheumatoid arthritis is less severe, it progresses more slowly, and it responds better to therapy versus developed countries where there's less parasites. And we have this, you know, the operation of the hygiene hypothesis where we just live in too sterile of an environment that our immune systems just, like you said, are going to get confused and they're more likely to have an autoimmune response to something that's coming through the system that they maybe should not even respond to. That's called immune tolerance. Your body actually has to have immune tolerance. You have to tolerate your own antigens, but you have to tolerate the antigens of other organisms. Because if you're responding to everything that comes to your body, then you're going to be constantly inflamed. So your immune system has to have a mechanism by which it can appropriately tolerate organisms. And in that particular setting, those organisms that are being tolerated may be doing something good for us. So if we're having immune tolerance for a parasite that isn't harming us, it's getting some benefit, but it's creating compounds that actually modulate and balance our immune system. That's a win-win.

Yeah. So I know this sounds completely wacky, right? But it's true. Dr. Hyman and Dr. George are giving patients worms.

Well, you know what?

Quacks or what's going on here?

I will bring in a patient and she will sit here and tell you that she is a believer in Helman therapy because she had severe psoriatic arthritis and we worked on everything. And her goal was to be able to either come off of or greatly reduce her need for her immunosuppressive Humira. When she came to see aches and pains in all of her joints, tired, fatigued, really having difficulties. And I did all of the things that we do, and we've talked about on this podcast in functional medicine. But one thing I brought up, you know, we've, I, I put her on a lot of things that could impact your immune system, Helmin therapy. So I started her on Helmin therapy a year and a half ago, and she in the worst, well, she was actually getting better from her pain, but she could not get beyond two and a half weeks without needing her next Humira. Started on Helmin therapy, helping her to get to that goal. She's now, she can go every six weeks before she needs a Humira shot.

Yeah.

And that started once she started the Helmin therapy. So, she's getting parasites, she's getting Helmin, she's getting these worms, she takes them in capsules, we get them from a really high level company and it really does work.

It does. I would say I've been shocked and I use it very selectively and patients who are really struggling and the usual functional medicine stuff doesn't work. And I think that I've been shocked at some of the things I've seen. I had this one kid who was on the autistic spectrum. yeah, but he was also extremely allergic, and he had really high levels of IgE, which is the antibody against sort of allergens when you have allergies, like asthma allergies. And I'm like, I told them, I said, look, I don't know if it's gonna work. I think the risk is very low. We use rat tapeworms, which sounds gross, but they don't actually get take up residence, and they don't actually. cause any real problems long term. They just pass through, but they can help regulate immunity on the way in. You want to try them? She's like, Sure. Was it really a miracle? This kid not only had reduction of all the symptoms and allergies and everything, but his IgE levels, which normally should be under 100, were 1000. And it came down to normal on this therapy. And I've had other people that have autoimmune diseases. kids. It's really quite striking. So there's something to it. You have to pick the right patient.

Absolutely.

And we'll figure it out.

But I just think that in functional medicine, the idea is that, you know, it's not like, you know, we just decided, oh, you know what? There's nothing else to do. Let's just, you know. Oh, I heard about, you know, witch doctors in, you know, in Africa using helms. I think I'll try.

That.

You know, there's a lot of research. You know, we know, I think we pride ourselves here at the Ultra Wellness Center in getting to the root cause, but really combing the literature for real data that says, you know, it helps us find new therapies that are going to be beneficial. And so we do that. And there is a lot of studies that support Helman therapy in reducing the severity of symptoms and response to medication in people with rheumatoid arthritis, psoriatic arthritis, MS, and asthma. Pretty amazing, right?

Yeah, it is. So it's, you know, this is, and it's actually in the mainstream medicine. It's mainstream medicine. And your doctor's really not doing it. And, and, and we're, we're a little kind of on the Leading Edge here at the Center for Functional Medicine. I mean, at the Ultra Wellness Center. And we're, we're really focusing on what's going to work for the patients. And we use criteria as like, you know, is there scientific evidence? yes. Is it safe? And if, you know, yes. Does it have bad side effects? Hopefully not. Is it reasonably priced? Okay. And if it meets those things, you know, we find a great therapy, but it's a million dollars a dose.

And some people use it.

Or it doesn't work. But so we really try things that are, are potentially helpful, and we work with our patients in ways that I think are pretty unique and inspiring, and it allows us to really see remarkable miracles where we often don't. So if you're listening to this podcast and you've struggled with gut issues, if you have autoimmune issues, if you have allergies, if you have cystic acne, if you have who knows what, you gotta start with the gut.

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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