How to Protect Your Menopausal Gut with Dr. Kiran Sachdev

50% of people more than the age of 50 often have low hydrochloric acid. The protein is getting fermented in their stomach and is producing that feeling of bloating and burping and reflux. You know, I talk the language of poop, and I would say, you know, when you feel that, you know, foul-smelling protein fart after you've had that 80-gram whey protein drink, that is an obvious sign that you're actually producing— you're going into proteolytic fermentation and not saccharolytic fermentation. If you do a variety Variety of exercises, that improves the variety or the diversity of the gut microbiome. There's a study which came out of Stanford in 2021, which actually compared fermented foods to fiber, and they found fermented foods actually won. They actually reduced 19 inflammatory markers. They improved the gut microbiome diversity.

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Dr. Kiran Sachdev, welcome to Well Beyond 40.

Thank you for having me here. I'm very excited to share what I have to offer and to help people.

I have been just sniffing around, looking at your stuff, listening to some of your lectures, start like, this is amazing, because you've been at this quite a while.

So, you know, I started off doing traditional GI, and probably 10 years ago, it— the thought arose, what am I doing? Is this really helping people? When people come in and I can't help them, there must be more tools in my toolbox that I'm not accessing. So I decided in mid-career to actually do 2-year fellowship while I was working in integrative medicine. And that led to me doing another board certification, integrative medicine. So in my current position, I'm at Susan Samlee Integrative Health Institute. I'm head of integrative GI, and I do both traditional approaches, and I then go into root cause medicine, which is basically integrative GI, looking at the gut microbiome and how it affects your body, and how can we modulate this highly malleable microbial ecosystem, which which is within us and change our physical output, how we look, how we feel, because that gut is ground zero and it's connected to almost every system of our body.

Did you fall like more in love with your profession when you, like, I think about this, what you were doing this for 20 years before you moved into adding in the integrative piece.

I am still in love with it. And it was 28 years of traditional GI and I was getting a little burnt out and I was like, I, why can't I help these people? And Now the world is opened up to me. It is no longer limited to traditional approaches. Oh, you have irritable bowel. Let's just throw that into that little trash can of irritable bowel. Here, take neuromodulators. Now actually I'm getting into the root cause of the people who have symptoms, not just gut symptoms, but how that microbiome affects aging and longevity and how we live to be healthier and not have comorbid diseases in the last 10, 12 years of her life.

I was actually super attracted to doing an interview with you because we're both at this conference, and I was looking at all the speakers, and you were talking about the gut microbiome and exercise, and I had never heard anyone talk about this. And then I, of course, started to listen to some of your lectures. So I've got a lot of questions for you. I want to— before we get into that piece of it, I want to just start with, because most of our women here are 50 plus and they're either in perimenopause or in menopause, What happens to the gut during that time?

So, you know, the perimenopause or menopause period creates a havoc for women because when we are not in menopause, we have that estrogen blanket. Our DNA is shielded, our microbiome is healthy. Now, all of a sudden, now the hormones go away. So basically our gut becomes very vulnerable. We don't have that healthy, well-populated rainforest, which has keystone species, which keep the bad bugs in control. And now we have the pathway microbiomes or the bad bugs which are on the rise. Our gut barrier becomes leaky. Then there is something called endotoxemia or leakage of those fragments of the gram-negative cells into our blood, which is called endotoxemia. That endotoxemia, and I know that sounds pretty like real, it is actually real. And if it becomes really bad, it can lead to sepsis. But in minor areas, it can affect the brain. Our cognitive function starts declining. We start getting the brain fog. Now we have certain good bacteria, however, which are making something called short-chain fatty acids, which go in there and they tell the brain cells, "Hey, no need for alarm, we can help." So always remember that the gut is influencing your bone. It is influencing your muscle. It's increasing your sarcopenia risk, increasing your osteoporosis risk. It is affecting your brain and that brain fog and the cognitive decline. Where did I leave my keys? That is a part of menopause. And it's also related to the balance in the gut.

How different would it be if a woman was, on HRT and started on HRT just as her hormones started to go down.

Yeah, I don't know if that has been studied, but definitely after the age of 60, there is a decline in your keystone species. The acro—

aren't on—

even if you're not on hormones, or even if you are on hormones, this is an aging decline, an aging outburst that we cannot outlive. Now, men, maybe, you know, this happens maybe 5, 10 years later, but they still also have the same decline. And so can we keep that environment healthier in the gut so it does not have bad effects in the rest of your body, yes. But I don't think there have been any studies so far about HRT and how it affects the changes in the gut microbiome long-term.

And these keystone bacteria that go down with age, couldn't we just back?

Yeah. And you know, yes. You know, so Akkermansia, which is one of your next generation probiotics, which is now available, that bacteria is important for your metabolic activity. It is a mucin degrader as well as it forms a robust lining in your gut wall. So your gut wall is not so permeable so that endotoxemia possibility or leakage of those lipopolysaccharides does not happen. So yes, we have next-gen probiotic Akkermansia. And I just gave a talk about Viennella. Viennella is that bacteria which recycles the lactate, which is a fuel which we produce when we exercise and we're tired and we're exhausted, and it converts it into actually a high-octane fuel, the propionate. And so yes, we have Viennella, the bacteria which in 15% of sedentary Women can improve their exercise performance, but they still have to exercise a little bit. There are things like, you know, from Japan which are coming out. It's called Myrosan or Clostridium butyricum. And that really reinforces that short-chain fatty acid cycle and the immune regulation. So we are coming across a lot of next-generation probiotics, but remember the keystone species are very sensitive to oxygen gradient in the gut. So if the oxygen gradient goes off or if you're trying to recreate these microbial species in vitro because they're oxygen sensitive, it's very hard to make them. So there are a lot of companies which are coming up and trying to make next generation probiotics.

Can you do a stool test and see if these things are shifting?

Is that type of testing available yet?

Yes. So, you know, that's what I do in my practice. I do shotgun genomic testing. Next generation sequencing testing, 16S ribosomal RNA testing. These are all different levels of testing the population of bacteria in the gut. The good, the bad, how it's reacting with your gut barrier. How is your digestion? Are you digesting your proteins well? Are you producing enough hydrochloric acid? All things, all loss of proteostasis, lack of hydrochloric acid, All these things happen as we start aging.

So as we start aging, I would think one of the first things that starts happening would it be like loss of hydrochloric acid? Is that pretty common?

And that is pretty common. 50% of people more than the age of 50 often have low hydrochloric acid. And they go to our traditional GI folks and the GI folks say, oh, you have a little burping, indigestion, here's a PPI. Burping and indigestion is not because there's acid coming up into their esophagus. It's because the protein is getting fermented in their stomach and is producing that feeling of bloating and burping and reflux.

And so they are given a PPI. What are the side effects of being given that?

So, you know, I, when I started practice probably in 1990s, PPIs were the fad, and they've been the fad for quite a long time. But in the last 7, 8 years, questions have been raised. Hey, is there risk for osteoporosis? Could this affect my brain health? Alzheimer's, Parkinson's disease? Could this increase my risk for infections like C. difficile? Could this increase my risk for pneumonias? And, you know, most of my traditional folks, you know, GI folks will say, hey, it definitely could affect your bone. The rest is all— we don't have any documented studies to really talk about this. But it is a true fact that if you cut the hydrochloric acid down to zero in your stomach, bacteria pathogens start basically crossing over that barrier in your stomach and they go into your gut and they can create havoc. You can get exposed to bacterial infections. You can lose the ability to digest your protein, which is so important for menopausal women to increase their protein intake. And they're increasing the protein, but hey, they're not even breaking it down and it's all going into the colon, into the stool. So all those considerations need to be, you know, considered.

We've talked on this show about anabolic resistance and the need for protein, especially the need or more protein as we age. How would someone know that they're not digesting their protein?

You know, I talk the language of poop, and I would say, you know, when you feel that, you know, foul-smelling protein fart after you have that 80-gram whey protein drink, that is an obvious sign that you're actually producing— you're going into proteolytic fermentation and not saccharolytic fermentation. Saccharolytic fermentation is what— which we need is basically the fiber, which is not basically broken down by human cells, is fermented by bacteria and produces these short-chain fatty acids, which are the magic currency in the gut. But if you don't balance your protein with fiber and you're just drinking that 80-gram whey protein shake, then you go into proteolytic fermentation and you produce things, ammonia, you get the brain fog, your thinking is not clear, which is often due, side effect due to ammonia production, or you get the hydrogen sulfide, which basically damages your gut lining produces these protein farts.

Okay, so protein farts are a sign. Are there— since there's such a high probability that someone has low stomach acid, is this something they should test for? Should they just do a trial of protein digestive enzymes?

So, you know, they can test for this, and I tell them do a baking soda test where you can take 4 ounces of baking soda and 4 ounces of water and put a tablespoon of baking soda, and you wait for 5 minutes to see if you have any burping. If you don't have any burping. That means sodium bicarbonate plus carbon dioxide should produce some carbon dioxide if there's hydrochloric acid. If there's no hydrochloric acid, they won't have burping. So that's a simple, easy test that you can do and see, hey, do I need some betaine HCl to supplement because my stomach is not producing acid? My advice to postmenopausal women is, yes, you need to increase your protein to 1.8 grams per kilogram body weight, not the 0.8 grams that we used to do in our youth., but you need to pair the protein with fiber or polyphenols because your body's ability to absorb that protein gets limited. But when you pair that protein with fiber or with, say, polyphenols like berries or something like that, your digestive system gets distracted. The bacteria get distracted. They let the protein get absorbed and they start fermenting the fiber and the polyphenols, and you get the full benefit of the protein you're taking. Again, split the protein into 3 or 4 meals. Don't do like 2 massive protein shakes in your body because it's all gonna be useless.

Any other signs that your gut's not aging well in general?

As we start aging, you know, obviously there's decreased motility. People get into constipation, they get into bloating. They're not digesting their food well because the population of bacteria in the gut is not balanced.

Balanced.

And if the bad bacteria take over, then you get signs of like metabolic disease. You get into cardiovascular disease. You get into bone loss of bone health. But in the gut itself, it's often people get into IBS. Now, all of them, they have IBS at the age of 60. And I don't— won't really call it IBS. I would call it dysbiosis or imbalance in the bacteria, which needs to be rectified. Even there is an inflammatory bowel disease has also a peak around 70. That's another thing to think about.

If your gut is, is aging, is it something that we can either slow down or reverse, or we just—

Absolutely. We can't change our own genes, but we can change the microbial health and the microbial genome, which is basically more than the human genome. So basically, when patients come to me, I first start with reinforcing the gut barrier. I help them digest the food well, and I help them balance a good bacteria, and then we go after the bad bacteria. So my kill phase, or trying to get rid of the opportunistic bacteria, which are normally in low levels, is probably in a month or two. But within 5, 6 months, we can get the gut balance. And the most important thing that I wanna tell everyone, the gut is a very malleable ecosystem, and it plays a very important part in our body. And by changing the gut bacteria, we can change the outcomes towards other diseases.

So someone listening right now, let's say they are not going to have a stool test anytime soon.

They can still start to do some things right now, especially with—

Totally.

—broccoli and fiber that are going to make a big— So fiber is something— there are no ads for broccoli. And honestly, fiber is so underrated, and we really need to improve our fiber intake. The average American probably has 10 to 13 grams of fiber. The requirements are 25 to 30 grams of fiber. Again, my advice to patients is start Start slow. Do not all of a sudden have— start having salads and vegetables and all. Always start slow, knowing the gut bacteria who are primed to digest the fiber, they might not be ready. And in some people, there is a fiber paradox where the fiber actually causes worsening symptoms because they're actually depleted. The gut microbiome is totally depleted of the keystone species. So when you give them fiber, they don't react well. So, and I use polyphenols and I use fermented foods where things are already predigested in the fermented foods, sometimes as a bridge towards giving them fiber. And then the polyphenols, like, you know, anthocyanins, grapes, berries, walnuts, pomegranates, they also form a very important nutrient source for certain bacteria like Akkermansia.

So with the polyphenols, and that's a really interesting thing. It's almost a test actually for the aging gut is if you eat fiber, do you have problems? Correct. And so if someone's eating fiber, starting up their fiber and they're having a problem, it could be because they haven't been eating fiber. So our body adapts to whatever we do. And so one of the first things you have to do is do more polyphenols. Now, are you doing that as a supplement instead so you're not hitting with as much fiber? Because all those things you just mentioned have a lot of fiber.

And so polyphenols in supplements like pomegranate extract does equally well, if not better, than if they cannot tolerate the actual fruit. Obviously, I would say, would recommend the actual fruit to most healthy people. But again, if you're starting from like the basics, then I would say, hey, take supplements, take pomegranate extract, green tea, you know, so other things that you could do which are not essentially fiber. So take a tablespoon of extra virgin olive oil, which is not like for cooking, but on top of your salad or in your smoothie. That extra virgin olive oil, which is cold pressed, is gonna deliver you so much benefit.

Now, if someone's rehabbing their gut, let's say they're doing an age reversal in their gut. And again, they have been eating a low fiber diet. Maybe they've been on a carnivore diet. I want to talk to you about that. Would they first start them with something like polyphenols? Could they start with fermented foods? And is the sign that they're having a struggle with these? Because I know sometimes people will start with fermented foods and have a struggle. Yeah, I'm not sure. Is that actually kind of indicative that there's more?

If they have trouble with fermented foods, then definitely SIBO is a very high likelihood. So in those patients, I would start them on prebiotics. Prebiotics are like fertilizers for all the probiotics. So prebiotics like partially hydrolyzed guar gum, which has, you know, the— and we think about guar gum and we think about it, oh my God, this is guar gum, but it's actually broken down, that polysaccharide is broken down into very small parts and they are prebiotics for a gut bacteria. Using like, you know, fermented whey that has got good sources of prebiotics, but not obviously in patients with SIBO, or using like HMO proteins. And human milk oligosaccharides are— yes, they're derived from breast milk, but say for athletes, they're using these highly specialized HMO formulations which produce little to no gas.

And SIBO itself, can you explain what it is?

So small intestinal bacterial overgrowth is SIBO, and it's basically the gut bacteria in the small intestine are usually not that populous or Usually the acid in the stomach prevents a lot of bacteria from residing in the small bowel. But when, say, the acid is low, or say you are not, say you took antibiotics, these bacteria, they overgrow in the small bowel and they produce gases like hydrogen, methane, hydrogen sulfide. They often can cause bloating. They can cause malabsorption of food. They can cause change in your bowel habits, either constipation or diarrhea, depending upon whether it's hydrogen or methane predominant. And now the new entity of hydrogen sulfide sulfide SIBO, which is again a part of proteolytic fermentation and is actually pretty damaging to the gut wall.

Is SIBO something that becomes more prevalent as we age because we reduce gut motility? Is it something that we're having more issues with? I wonder about GLP-1s because they slow down stomach emptying. Would that cause more issues? All of the above.

You know, as we age, one, we lose the power to chew well, so we don't eat that much fiber. The acid in our stomach goes low, the motility starts going down. So all those things do contribute to SIBO, but the biggest factor in terms of SIBO is the polypharmacy and the antibiotics and hospitalizations and nursing home exposure. And as far as the polypharmacy, besides the antibiotics, PPIs, proton pump inhibitors, which cut the acid down, which are not necessarily needed in everyone. So for me, you know, if somebody has reflux, I do an endoscopy, I put a little capsule in called a Bravo capsule. It monitors how much acid do you have during a 4-day period. If you're not really having any abnormal acid and you're having a little bit of heartburn, I control this with sodium alginate supplements. I give DGL, I give Slippery Elm, Marshmallow Root. There's so many demulcents we can give, or the alginate supplements, which can control mild reflux symptoms. And you don't need to jump and take the PPI and then again destroy your whole gut microbiome.

Again, doing any kind of dietary prescriptions, it is protein plus fiber. That's my— like, those are my two that I focus on. And I just— I always get asked about the carnivore diet. And while I see it as maybe a short-term elimination diet, I'm now seeing people who have been on it for years. I've got a friend who's been on it now for 2 years. I'm like, oh my goodness, we need to test your gut microbiome. What's your thought about it? What happens to the gut on a carnivore diet?

So carnivore diet is, you know, full of meat. There is no fiber. So all the keystone species are starving. The Akkermansia, the Faecalibacterium, the Roseburia, they're dying. And basically there's an increase of proteobacteria. I mean, yes, we on a carnivore diet with low carbs, we lose weight. It helps our brain with the ketosis, all that stuff. But honestly, it's not a sustainable diet and it's not going to help with healthy aging, and it's going to affect our biological age, which is the actual age of our cells.

Is there a way that you could actually test for that to show?

The gut microbiome test?

I would love to show him what the heck is going on.

So gut microbiome test? Gut microbiome stool test is your answer. We don't know what the optimal gut microbiome is because the gut microbiome is so unique. It is like your, you know, fingerprint. And, you know, based upon your ethnicity, how— where you— you had breastfeeding, did you have vaginal birth, did you have antibiotics when you were a kid, what did you go through, the stressors, did you go through your life, all that stuff, this all affects your final gut microbiome. History book. Exactly. It's like a history book. And when I talk to my patients, I ask them what happened to them in childhood. Did they have antibiotics? Did they have vaginal birth? Were Were they breastfed? Were they, when was food introduced? Did they have any food allergies? Did they have asthma, atopic dermatitis? Because if there's too much of sanitation, then patients are in young age developing asthma, atopic dermatitis, all that stuff. And that microbiome affects even say brain size. So people with ADHD, autism, that microbiome affects your brain, your brain development. And then later on life around, you know, after the age of like, say, you know, 3, microbiome gets stable during adolescence. It might have some fluctuations with the hormones and it kind of remains stable until you hit that age of 60. Then it starts declining. Then we get something called inflammaging because the microbiome shifts from good bacteria, which basically kind of die off because we're not feeding them and we're not taking care of them. And the gut hates a vacuum. The bad bacteria take over and they cause this low-grade lipopolysaccharide secretion into our blood, which causes this process of inflammaging, where there is chronic smoldering, low-grade inflammation in the body without, like, say, a detectable pathogen. And that kind of ages all our organs. Our immune system also responds to it, and it starts going into immunosenescence, or we lose that naive T cells, which are ready to run to jump in for infection, and we have these old memory T cells, which are sluggish, we become more prone to infections. Our response to vaccines goes down. So these are all arising from that changes in the gut microbiome. And if you're proactive and we change our gut microbiome around that age or even before that age, and we can even change it afterwards, we can maybe halt the progression of this inevitable, you know, biological decay that we think is aging.

So it sounds like the ultimate longevity diet then would be optimal protein and a variety probably of fibers.

So yes, 30+ fibers, 2 or 3 servings of fermented foods, and then 1.5 to 1.8 grams per kilogram protein, which is split into 3 or 4 meals and paired on you know, with some fiber or polyphenols would be the optimal diet.

Okay, so let's talk, because I know there's different types of fiber, but most fibers have multiple different types within them. So trying to sort it out, how important is it to focus on making sure you're getting some resistant starch or some prebiotics and some soluble? Do we need to like get that granular with it or not?

Well, if you want to get granular, yes we do. We should have at least 10 to 15 grams of soluble fiber in our diet because that That soluble fiber feeds our gut bacteria. The rest of the fiber can be insoluble because, hey, we need bulk to help the stool move out of the colon. So we need insoluble and soluble fiber both. We don't need to just focus on salads all day. We can add a little bit of oats, legumes, you know, whole grains. That is gonna provide us the soluble fiber.

And as far as the fermented foods go, how would you have someone start who doesn't eat— I mean, this is just not,— part of our culture. So someone who is not used to eating fermented foods, how would you start them? Because I would assume you'd have to have some adaptation in their microbiome with those. And what— like, when you say a serving, what is a serving? How much is that?

So they did a study, and yes, fermented foods are not part of all cultures. They're still hidden and still there. And what's good about fermented foods, they have prebiotics, probiotics, and postbiotics. Everything is digestible and readily available. If you don't have any bloating, gas, or SIBO kind of symptoms, I I would say start some fermented foods, start slow, start with 1 serving, and then slowly increase it to 5 or 6 servings. There's a study which came out of Stanford in 2021, which actually compared fermented foods to fiber. And it was 6 servings of fermented foods versus 20 grams of fiber in these 39 people. And they were followed over for 10 weeks. And they found fermented foods actually won. They actually reduced 19 inflammatory markers. They improved the gut microbiome diversity. Granted, the people who were given the fiber, if they had a very attenuated microbiome or they were lacking their keystone species, then they didn't respond to fiber. So my advice would be to start slow, but at least get into 3 servings of fermented foods, whether it is through miso, tempeh, coconut yogurt, sauerkraut, kimchi, you know, any of the stuff. And each culture has their own different fermented foods.

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I was in Korea a couple of years ago, and every meal you got all the side dish. It's an acquired taste when you were not raised with this stuff, right? But when you say a serving, how much would a serving of, say, kimchi—

you know, like a couple of tablespoons of kimchi, you know, just put in not much. Put it on the side with each time you eat. One serving of kimchi, coconut yogurt another time, a little bit of miso soup, you know. So it goes a long way. Some places have these, you know, this place called Fermentation Farms, which actually ferments the stuff, and you have the brine. So even you just take a little shot, tequila shot of the brine.

I have been working on it because it's so clear, and I, I heard you do that lecture where you talked about about the fermented food versus the fiber, I was like, oh my gosh, it sounds like the ultimate anti-aging gut diet would be fermented foods plus fiber plus polyphenols and maybe even making sure you're like drinking some green tea.

So, you know, there's a New Age trial which actually talked about the Mediterranean diet and it studied like around 600 people in 5 European countries over a year and they just gave them a lot of leafy greens olive oil, lean poultry, maybe a little bit of red meat, but less red meat, a lot of nuts, whole grains. In that study, that New Age diet study was really radical about how a Mediterranean diet is probably your longevity diet because it decreased all the inflammatory markers. The CRP went down, the inflammation markers went down, the people's biological age, which is measured by different kind of, you know, speedometers, the Dunedin Pace, that improved. Improved. The gut microbiome improved.

I remember Cara wrote Younger You, looked at all of that, and I just wonder, it seems when you look at the Mediterranean diet, you've got a lot of polyphenols naturally in it, especially with all the really nice olive oil. What about the wine piece of it?

Wine piece of it is plus and minus. It's a plus and minus. The wine piece—

someone who's listening who is on the carnivore diet, diet, what would you say? Like, how would you kind of pull out of it?

So, you know, people go on the carnivore diet, say they have SIBO and they're getting recurrent SIBO. Some of my patients have gone on the carnivore diet because they don't want to introduce fiber because they're afraid of fiber. So, and so, which is why I use the polyphenols. I use easily digestible fibers like oats, like simple foods like rice. They are not going to be that much of a shocker to the gut as, say, you know, eat a piece of kale or eat arugula or leafy greens or Yeah, that makes sense. You know, sweet potatoes, peeled potato. You can even use like potatoes or rice. You can actually put them 24 hours in the fridge and they become resistant starches. So that's a good trick to do to feed the inner gut is not eat the fresh rice, but put the rice in the fridge.

Here's the question, because we do that at home. We'll make— we always, whenever we're making potatoes, we make them so we can have them the next day. Once they've cooled down, you can reheat them and still maintain that and still maintain the nutritional value. As far as the Japanese go, I know we just We've talked about the Mediterranean diet, but the Japanese seem to be doing a lot of right things too.

Oh, they are, because, you know, there's a guy, Elie Mettenkopf, and this was, I think, in 1906, he got the Nobel Prize, where he said that aging is this process that we need to improve, and we need to start drinking putrefactive milk to reduce the autotoxins. How'd that go? And I'm not asking everybody to drink putrefactive milk, to milk, but Japan as a culture embraced it. Western culture wants to give antibiotics to kill all bugs. All bugs are bad. But Japan made that ecosystem, honored that. And it now has made these two beautiful products that I'm listing about. One I told you about was Myrosan, which is Clostridium butyricum, which really gives that short-chain fatty acid directly to the gut and reduces inflammation. The other product is something called Daigo. And Daigo, they ferment Lactobacillus lactis for almost 13 strains for almost a year, and they create a postbiotic. So to get away from the gas and the bloating of probiotics, we now are going into this world of postbiotics, which are basically inanimate organisms or heat-killed organisms, their parts or their secretions, which work work as good as in the gut as, say, the live probiotics, even better, because one, you don't have to taste them. They are shelf-life stable. They're resistant to the acid in the stomach or the bile acids, which destroy the live probiotics. And now we get these wonderful postbiotics, which actually do the work in our gut, and they— we don't have to wait for their effect to happen for long, and their effects are longer lasting. So we're using now postbiotics even for athletes to help with better performance and immediate results.

I would love to talk a little bit about fasting.

So fasting is phenomenal for autophagy, or for like clearance of all your dead cells in the body. Because imagine if we are a car engine which is running all the time, 24/7. Well, the mechanic doesn't have time to go and check the hood and see if the parts are, you know, maintained or not. And that's what we need to We are in a place where we have nutrient overload. We have constant food and we're constantly eating that food. So our body doesn't have time to clean the dead cells, repair the mitochondria. The best diet that I would recommend is a fasting mimicking diet where for 5 days, not every month, Walter Longo's diet, which is 5 days, not every month, but they can do it every 3 months or whatever. They go from 1,100 calories with a certain certain set of profile of macronutrients where there's really not much protein or carbs, but same amount of fat. And you kind of reduce that as that fasting cycle progresses. We go from now using fats as a source of nutrition, and then we go into basically building your stem cells in the gut and renewing the stem cells. So this is a longevity plan. It takes at least 24 hours of no nutrients for your gut to rebound back to really going to the ketogenesis state and the autophagy state. So the 16:8, I'm not sure. I mean, it works short-term, but as a longevity diet, I would say the fasting mimicking diet by Valter Longo is probably what I would recommend.

One of the things that I take religiously is urolithin A.

So urolithin A is another, you know, miracle of what is happening now. And it, you know, it is basically made from pomegranate and ellagitannins from pomegranate. They are broken down in some people, and I would say probably 15 to 30% of the of the population have this Gordobacteria, and that breaks down the ellagitannins from pomegranate into a compound called urolithin A. And this urolithin A does miracles. There's a study from 2022 where they gave it to sedentary people, average age 52, 1,000 milligrams of urolithin A for around 4 months, and they had 12% improvement in their muscle endurance, their VO2 max, their 6-minute walk test, and all the plasma glycan acid, acyl carnitine levels, and the CRP levels were all reduced. Now, there's another study in athletes in 2025, and that showed 42 athletes who were actually running 100 miles every day, 100 miles a week, they actually started taking urolithin A, and their VO2 max, the performance indicators, all improved. So it It is upcoming and it definitely, it's an area to consider.

Yeah, it's definitely one that I could tell the difference. It's to me as close to exercise in a bottle as there is, but even better when you pair it with exercise. Right. So let's talk about exercise. How does exercise— because I heard you talking about this and I was like, I've never heard this, that when you do a variety of different exercise, it impacts your gut microbiome diversity. Right.

Say an endurance runner and a person who is doing a marathon, immediate energy. So they have increased carbs, they produce a lot of short-chain fatty acids, their microbiome changes. It is maybe composed of Veonella and Prevotella as opposed to say a weightlifter. Weightlifter needs these short bursts of power and energy. So it needs bacteria which produces protein like branched-chain amino acids. And actually certain Bacteroidetes species actually produce branched-chain amino acids for that athlete. So we can tailor, you know, we can understand the gut microbiome profile and we can actually tailor our treatment for those athletes. So in the people with the endurance athletes, we really need to worry about gut ischemia. So we need to really increase that Veonella concentration, while in the people who are the weightlifters and say the sprinters, we need to remove the products of protein breakdown because they're eating probably 2 to 2.5 grams per kilogram body weight of protein. So we need to actually add nitrogen scavenging bacteria back into their microbiome to help them remove that protein load.

Now you have the woman who's 50 plus who is— hopefully this is what I'm recommending, gals— you're walking, getting your steps in, you're doing some hit training and you're doing your resistance training, maybe some mobility yoga. So they're doing some movement every day, but they're doing a variety of different things. I'm assuming what you just described would be someone very professional athlete trained specifically for sport, but it would seem like if someone's doing a diversity of things now— Definitely.

There's a study which just came out which says if you do a variety of exercises, that improves the variety of the diversity of the gut microbiome. So combining like HIIT training, which is, you know, I would say zone 5 training, zone 2 training, majority of the time you should be in zone 2 where we are able to talk. We are only doing 60 to 70% of max heart rate. And then going to 20% of zone 5 training, which is basically high-intensity training and doing 150 minutes to 270 minutes a week and combining it with 2 or 3 sessions of resistance training is what's recommended. Resistance training actually builds that muscle much more than aerobic training, and 33% increase of strength of your muscles with resistance training. So again, I would definitely advocate doing— do some weights, even if you don't like them, do some weights. They're really important for your body and for your muscles.

So for that athlete who's very much, or maybe even the weekend athlete who, let's say, is focusing on endurance training, wouldn't it be better for them to add in some resistance training as well to support a more diverse microbiome.

Absolutely. Not just a more diverse microbiome, but if you're really doing running and you're not improving the stability of your muscles, which is you need to do weights to improve the core stability of your muscles. Running is gonna lead to injuries if you don't combine both resistance, because you need to build your muscles so that if you sustain injury, microtears, all that stuff which happens after a long race, you need to heal those tears. So I would recommend, say, you know, you're, you're starting training and you really need to up, up your fiber because when you up, up your fiber, you increase your short-chain fatty acids. If you're really serious about your training program, when you start your training weeks before your race, 14 grams per 1,000 calories, that is the recommended added, you know, fiber intake, 4,000 calories, which is 56 grams for, say, someone who's having 4,000 calories. So it's a lot more than your average Jane or Joe, which is probably just having around 13 grams of fiber. But increasing the fiber, ramping it up, stopping it before the race, 3 days before the race, you gotta stop that. No fiber unless you want to have bloating and you cannot succeed with your race. Then pairing the protein with fiber and polyphenols, that helps. Then using, you know, like antioxidants, like, you know, polyphenols, increasing your carb load. If there's a 4:0:6 plan, where 40 grams, 400 grams of carbs, 60 grams of fiber, starting 2 days before the race, that helps you get through the race. So, you know, just like we need dollar bills, the short-chain fatty acids are the currency, how the gut talks to the brain. Gut communicates with the rest of your body. So short-chain fatty acids are produced by fermentation of the fibers that a body cannot digest, and there's certain bacteria which are very adept in producing them. There are 3 short-chain fatty acids: acetate, propionate, and butyrate. Acetate is the major— 70-80% of the short-chain fatty acid. What it's important for is cellular respiration. It goes into the mitochondria and it produces produces oxidation, oxygen, and it helps with managing your— it curbs your appetite. It is linked with insulin resistance. Propionate is the one which goes into your liver, and it's basically— so acetate is acting in the periphery. Propionate goes into your liver, and hey, during a long run when you're really— the blood sugar is low, you do something called hepatic gluconeogenesis, where you actually produce glucose from other substrates. And so that helps us in endurance races and runs. So we don't feel the fatigue. Butyrate is the king. Butyrate does work not just in the colon. It actually provides 70% of the energy to our large intestine cells. It also helps with creating that oxygen gradient because we need the anaerobic or low oxygen in our gut for the keystone species to survive. So it helps those keystone species to survive, but then it goes into the blood and it acts is a signaling molecule. It goes into the brain through the blood-brain barrier and says, hey, I want happiness. So it grows the BDNF, or brain-derived neurotrophic factors, which reduces inflammation and helps with the brain. It goes into your muscles and it increases the mitochondrial biogenesis. It increases the muscle synthesis. So that's the one that we really, really need to have our body perform in an optimal way.

What about About this, I've looked at a lot of stool tests. It seems to be one that people are low in. I would assume resistant starch would be one of the good things to do here, but while you're getting your levels back up, would taking butyrate help?

Yeah. So butyrate, if you take it, you need to understand that like anything, we have to face the havoc in the gut, the acid in the stomach, the bile acids in the small intestine, and it has to be delivered into the large intestine. Intestine. So taking butyrate in forms where there is no coating, no fatty acid coating, is not beneficial. So tributerin is a form of butyrate where there's a fatty acid coating and it delivers it right into the large intestine, which is where it's needed. Otherwise, other forms of butyrate get absorbed up higher and it really does not benefit the large intestine.

If you had to just simplify it down, the best diet for gut health.

Best diet for gut health, it depends upon where your gut is. But to be honest with you, it is the Mediterranean diet, which is, you know, plant-forward, less— low amounts of red meat because red meat is really not good for us in large quantities, focusing on lean poultry, legumes, grains, a lot of leafy green vegetables. And, you know, a balanced diet is probably the best diet.

And what about some non-negotiables here in the diet? Any ones that you have here that you just do not do this? I know everyone loves to say everything in moderation, but I don't agree with that in some situations.

Well, a standard American diet with ultra-processed food, which is low in fiber, high in carbs, high in fats, is non-negotiable. Not in this day and age, and not with the wealth of knowledge we have. It is absolute destruction for our gut microbiome.

Seed oils. Right. Thoughts on those?

So seed oils are, you know, it's interesting, but it depends upon how are they processed. If they're hydrogenated, those seed oils are like fire. They literally destroy our guts. If they're not hydrogenated, then yes, we can think about them. And what about artificial sweeteners? Artificial sweeteners are a big no-no because they really cause damage to that intestinal barrier and you develop leaky gut and then you develop endotoxemia. So, you know, really honestly, there is no artificial sweetener that I can really recommend.

There's just still this information out there, I think, because people are just looking at calories, right? And then they'll go, well, we did a weight loss study and people who drank diet soda lost weight. I'm like, but at what expense?

Yeah, so it's not about calories, it's about the quality of food you put in your body. The quality and the quantity, yes, but the quality of food is really important. If you have you have no high-processed food, if you're not eating a lot of fat or you're not eating a lot of saturated fats, you're eating good fats and you're eating fiber and you're eating good quality protein, that's what matters. And that actually, you know, triggers the bacteria. And the bacteria actually produce these— the propionate, it goes and works on the GLP-1 and your PYY receptors and tells, hey, the hypothalamus, hey, you don't need to eat too much. Or the Akkermansia, which is a metabolic, you know, bacteria. It helps with, again, with metabolic dysregulation. So my thing is grow the right bugs in your intestine rather than worrying about calories and, hey, I wanna be on a no-fat diet. All those things are gone. And we need to focus more in depth in what's really happening in your gut.

Do you think some of the issue right now with the GLP-1s and the reason that they're working so well because we've damaged our gut microbiome and our L-cells can't produce these things or resistant to it? Is there anything in there with that?

So the GLP-1s are tough. They work great, you know, with all these metabolic issues with— now they're thinking even about addiction in the brain. But if, say, you combine the GLP-1 with Clostridium butyricum or you combine it with Daigo, then you counteract the slow motility and all these factors factors and still get the benefit of weight and reduce metabolic issues with GLP-1s. I think that is something to be studied, but it definitely, you know, they're there and we definitely need them. You know, obesity is another epidemic which I haven't spoken about. So we definitely need to focus on that. But I think we can combine it with postbiotics and we can combine it with precision probiotics to help maximize the benefits of GLP-1s. And reduce the side effects.

I haven't heard anyone say that, and that makes so much sense, because as I was looking at them, I'm like, seems like this could be a precursor to SIBO if we are not careful, but what you just said would then take that off the table.

Well, I mean, they're good drugs, but they do have side effects, and the question is, how can we manage them so that the side effects don't become the biggest issue?

One more before we go to the speed round. This last December, I was actually for New Year's Eve, I was in the Amazon. And I was in the Amazon for 10 days on this trip living with the indigenous people. And it was all great until it wasn't great until I got a big bug bite on my butt. Like, big. Like, I was like, I can't sit.

I ended up with the doctor.

I was like, my Spanish got really good. I used to be fluent. I pulled it back out. Leg up over my head, look at this. Anyhow, I ended up on a round of doxycycline. Then he put me on Cipro and Flagyl. Then I went back and home and they put me on doxy again and I'm like just going, oh goodness, I'm gonna have to fix this. What would you say, how would you go about repairing that kind of damage?

So that kind of damage is spore-based probiotics. So spore-based probiotics are again up and coming and new and Bacillus squagglans subtilis. Bacillus, these are spore-based probiotics, and Saccharomyces boulardii. So they're used for antibiotic-related damage or damage to the gut. So basically they do something called quorum sensing, or they sense the room, they read the room, they read your microbiome and they say, hey, this one is lacking, this one is big. And they actually reduce 40% of that lipopolysaccharide, which is produced with now probably you have an imbalance of bacteria. So those proteobacteria are now producing the lipopolysaccharide and spore-based probiotics reduce that lipopolysaccharide. So using spore-based probiotics in this kind of setting would help somewhat get the microbiome back to its normal condition.

So someone being put on antibiotics, is this something they would do while on the antibiotics or they need to wait till they're after the antibiotics? And what's the protocol? How long would they need to be on them?

—get them back? So I would say Saccharomyces boulardii or Metaspore Biotic. These are the ones I use a lot. I would say during the duration of the antibiotic and maybe 6 weeks after, because remember, we are trying to create— we're trying to navigate this huge ecosystem which is disturbed. So some bacteria have to die and some bacteria have to grow. So it'll take at least 8 weeks before we see results. Okay, that's fantastic.

Ready for a speed round? Yep. Best food for gut health? Bananas. Bananas.

I love bananas. I'm sorry, plantains. No, green bananas. How is that? Green bananas are the ones which are really good for gut health because they're prebiotics. I got it. Yeah. Green bananas and broccoli.

Most overrated gut trend?

Fiber maxing, protein maxing. Fiber maxing is again another trend where people are eating too much fiber because now they're hearing fiber, fiber, fiber. And so now they're eating too much fiber, but But if they have a depleted microbiome, then they have all these issues. Then they're like, we're not gonna eat fiber anymore.

Okay. One supplement that's worth it. Akkermansia. One that you would skip.

Well, I take omega-3s. I take my vitamin D3. I take my urolithin. I take the Akkermansia, the pasteurized version, so that I don't have to do the live version because the live version takes time to grow in my gut. So I take the pasteurized version, which is the postbiotic version. And now I'm taking Daigo. Um, which supplement would I— and I take magnesium.

You named all my favorites too, except for creatine.

I also love creatine. And creatine.

Creatine is very important for muscle recovery. Let's see, so we didn't get to the one you'd skip. I know, I was like, don't take my supplements away from me.

I'm like, you know, I take a few. I don't take a lot.

That helps with you'd kill tomorrow.

That the gut microbiome is not important. The gut microbiome is so important and that gastroenterologists really need to focus on the patients who are coming in with persistent bloating and persistent complaints. And they're saying, hey, this is irritable bowel, here, take a Bentyl or take a Lepsin and go home. I think there is more to it than our eyes can see and we need to look further and deeper and really help these people been suffering for years sometimes.

And you need to get out there and teach the practitioners.

Yes, I do. We need more of you. So, you know, it— as my, you know, besides being head of integrative GI and Susan Samueli, I'm also associate professor at UCI, and we have fellows which are coming through the clinic which are learning all this stuff. Good. So the future generation needs to learn that, hey, this is not cutting-edge GI, and this should be taught in medical schools, and it should be part of their core curriculum.

And can someone come, a physician come in and do that program, or do you have to be in the UCI medical program to begin with, or could you from the outside come in?

You could probably come in through the outside and, you know, just follow me around, but when I'm teaching, it's I'm teaching the fellows or I'm teaching the medical students. Students. It's taken me 60 years to get there.

Well, you've got— you've gotten there.

You're here. And my enlightenment happened in my mid-50s. So, you know, but it was a true enlightenment, which now I'm so passionate about, as you know.

Isn't it fun to be more excited? I'm more excited about what I'm doing in my career now at 63 than I was at 50.

I mean, there's so much— well, you're so bogged down, I think, with life and kids and work and careers, and you just don't see the big picture. And I think you have to sit, and every physician, you know, will come to that point where they really need to sit with themselves and say, am I doing any good? Am I doing the job that I decided to do when I first started? Am I healing people? And healing people from within is the most important thing for me.

Thank you for doing what you're doing. It's amazing. Thank you.

One thing people forget about on their fat loss journey is digestion. When you're changing what you're eating, how much you're eating, and when you're eating, your digestion changes too. You may be feeling any of these things: you feel backed up, a little bloated after your meals, maybe some cramping, or just overall ugh. One of the foundational things that I recommend during this time to support your gut is is sodium butyrate. So what is sodium butyrate? So butyrate is a short-chain fatty acid that's produced by your beneficial gut bacteria, and it's actually one of the primary nutrients for all the cells that line your gut. And when those gut cells are supported, digestion, comfort, regularity, it all works better. And that is why I added BodyBio Butyrate to my daily routine. If you're in the process of upgrading what you're eating, how you're eating, when you're eating, head over to bodybio.com/jjvirgin to start supporting your gut today. Be sure to join me next time for more tools, tips, and techniques you can use to look and feel your best and be built to last. Also, I'd love to connect with you and hear your thoughts on the podcast. Here's how. First, subscribe to the podcast and leave an honest review. Second, take a screenshot of your review. And third, text it to 813-565-2627. That's 813-565-2627. When you do, I'll reply using my brand new virtual JJ Virgin. It's my on-demand virtual self built from my books, talks, and years of experience so I can interact with you directly. You'll make my day and I can't wait to hear from you. Thanks for tuning in and I'll catch you on the next episode. Hey, JJ here. And just a reminder that the Well Beyond 40 Podcast offers health, wellness, fitness, and nutritional information that's designed for educational and entertainment purposes only. You should not rely on this information as a substitute for, nor does it replace professional medical advice, diagnosis, or treatment. If you have any concerns or questions about your health, you should always consult with a physician or other healthcare professional. Make sure that you do not disregard, avoid, or delay obtaining medical or health-related advice from your healthcare professional because of something you may have heard on the show or read in our show notes. The use of any information provided on the show is solely at your own risk.