The Gut MD: “95% of Serotonin is Made in the Gut!” How the Food You Eat is Tied to Anxiety & Depression

Turns out that 95% of serotonin is produced not in your brain, in your gut. Come on. I was in a dark place and making that change completely radically transformed my health. And because I had that moment, I'm a medical doctor and I care a lot. So I felt like I have no choice. I have to bring this into the clinic.

A board certified award-winning gastroenterologist, two-time New York Times bestselling author, the man with the master plan for the microbiome.

Welcome.

I've talked to a Boluswitz. Dr. Will Boluswitz.

Dr. Will Boluswitz. We got 38 trillion microbes. Now, this is, by the way, more.

Than we have human cells.

Really? Yeah, we were less than 50% human. How many times should we be pooping a day? Let's just get right to it.

I'm just curious. I'm so glad that you asked this question. Inflammation influences anxiety and depression. Oh, 100%. You could do all the right things physically, but if you don't emotional or psychologically, you can't take off as a human being.

100%.

That is fascinating.

I think this is the missing piece that a lot of people haven't heard and they need to hear. Wow.

Welcome back, everyone, to the School of Greatness. Very excited about our guest. We have the inspiring Dr. Will Bulsiewicz in the house, who is the US Medical Director at Zoe and also a New York Times bestselling author and also a gastroenterologist.

Amazing.

Welcome. to the show. Very excited.

Thank you, my friends. It's great to be here.

I'm very excited. There's so many things I wanna talk to you about. The first one being the connection between the gut and the brain and how much gut health actually impacts mental health. There's a lot of anxiety, stress, overwhelm, mental diseases, or just blurriness mentally, it feels like in society today. How much does our gut health impact our mental health?

We've seen these conditions that are escalating, depression, anxiety, different mental health disorders, different cognitive disorders, including Alzheimer's disease, Parkinson's, things like this. And the question is, what the heck is going on here? And when you see things changing this quickly, it's not genetic. So you have to take a step back and say, what is it about our environment what is it about the way that we live that ultimately is resulting in this effect?

Because we didn't have all these mental health issues 50 years ago.

Well, they existed. They existed, but they didn't exist to the level of intensity or the number of people that are being affected by these things as what we see today.

Right. Right.

And these are complex issues. So to sit here and pretend that this is just this one thing, you know, hey, it's the gut microbes, that's all that matters. that would be oversimplifying it. But I think that the important point though that the listeners need to hear is that they do play, these gut microbes do play a role. So in order to introduce this conversation, I feel like let's take a quick moment, take a zoom out, and let's talk about the microbiome, which is the living microorganisms that are a part of our body. There are 38 trillion microorganisms that exist covering all external surfaces of our body. So they're on our skin, on the top of our head, our scalp, literally they're crossing my eyeball as I sit here and look at you and talk to you. But they're so small, I can't see them, so thankfully they're not affecting my.

Vision in any way. So these are like little bugs?

Little bugs. How many? 30 trillion? 38 trillion. Bugs. 38 trillion.

We call them gut bugs, but really we're talking about bacteria? Bacteria.

That is around, that's on the skin guy. That's on the outside of our body and our inside of our body. Well, so here's an interesting thing about that. It turns out that what's inside of our body, we're talking about our intestine, is actually outside of our body. Yeah, bizarre, I know.

Our intestine is on the outside of our body.

Okay, so here's the thing. Your tube is your intestines are a continuous tube. It starts at your mouth. Now, you're a tall guy, much like me, okay, but the average person in the United States, somewhere between 20 and 28 feet. Okay, is this continuous tube of intestines? 28 feet, okay? The tube is never broken. All right? There is no point where things that enter into the tube leave the tube and go into the body unless they're absorbed by the body. Interesting. So basically what that means is because it's a continuous tube, it starts at your mouth, which is outside of your body. Things are outside of your body. You swallow them down. You may think of them as being inside your body, but actually they're within this tube and they never actually enter into your body. So all the way through, this is actually an external facing surface. Interesting. You're interacting with the outside world, which is one of the key points to understand is that you're interacting with the outside world within your intestines. So this is the reason why, by the way, Louis, that 60 to 70% of our immune system lives in the wall of your intestine. This is the home of your intestines. People may think of the bone marrow as being, Hey, that's where immune cells live. No, no. they're born there, they may be born in the bone marrow, but then they move to other places, much like you were born in Ohio and I was born in New York and now you're here and I'm in Charleston. The immune cells move and most of them take up residence within the lining of the intestines and the reason why they're there is because this is actually where we're interacting with the outside world. And so we need our defense systems in place in that location. Alright, so anyway, so here we are, we got 38 trillion microbes. Now this is by the way more than we have human cells. So we are less than 50% human. Wait, wait, wait.

How many human cells do we have? About 30 trillion. 30 trillion human cells, 38 trillion, what, non-human cells? Non-human cells. Really?

Yeah, so they're clearly outnumbering us. There is no doubt you are definitely less than 50% human. And actually, if we took your 30 trillion cells, if we took your 30 trillion cells and we moved the red blood cells, and the platelets, which by the way aren't like the classic cells. Like when we think of cells, I think we all have a picture in our mind of like the cell with the organelles, the mitochondria, all these things, right? So if you took just those cells, you are actually about 90% microbial and only 10% human.

And so a microbe is not a human element.

No, it's not. And it's also not a part of our body. They take up residence after birth.

That's crazy.

Yeah, so the water breaks, the water breaks, mom goes into labor, and for the first time, the baby is exposed to the outside world. And with that come a flush of these microbes. And actually passing through the birth canal is a gift from nature, because as a child passes through the birth canal for the first time, it's being exposed to this world, this microbial world that dominates. and they've been around, Louis, so like humans we've been around for about three, three and a half million years. Archaea, which live inside of our microbiome, okay? They're not bacteria, they're not fungi, they're these weird things, but they produce gas, right? So when you pass gas, think of Archaea. There's an archeologic site in Greenland where they found four billion year old archaea, four billion years. And we think that that's the oldest life on this planet.

Wow.

So these microbes, they have been around forever. They've survived everything that exists. No matter what happens in this world, no matter what happens, there will be microbes. They will continue to exist. And they're an important part of us as humans, which is really the key point, because we can't be our best selves without our microbes there to support us.

Come on, really? So how much of our bodies is actually human versus non-human? What's the percentage?

So human versus non-human, clearly less than 50% human. Okay, clearly less than 50%. Some would argue 10% human. And then if we were to talk about your genetic code, you are less than 1% human.

Come on.

Yeah.

So what are we?

We're a mish-mash. We're super organisms. We're super organisms. Wow. That are a mish-mash of these microbes and we think of ourselves in isolation like, hey, we're these big, strong humans, but actually the big, strong humans would be quickly broken down and weak humans if they didn't have these microbes to back them up. They back us up.

If we didn't have these alien organisms crawling over our body, we would not exist is what you're saying.

Well, I mean, we think of them as alien, but they're more native than we are. They've been around for 4 billion years. Interesting. So, yeah, and so now with the gut-brain connection, So the gut, we rely on these microbes. This is where they live. They are most concentrated within our colon. That's their number one location. Yes, they're on our skin and our mouth and a woman's vagina, all these places, but they're most concentrated in the colon. And they're involved in these core essential parts of human physiology, digestion of our food, access to nutrients, shaping our immune system, which is inflammation. Our metabolism, on multiple different levels, these microbes are key players in our metabolism. Our hormones, so like for men, androgenic hormones that make us feel masculine, they play a role in that. Yes, there are connections between microbes and erectile dysfunction.

Wow.

Yeah.

Really?

Absolutely.

Okay. This is how we get guys to.

Listen to this show. Like, okay, wait, how do I have better erections? Alright, now what do I do? But for women too, for women too, it's connected to estrogen and estrogen metabolism and multiple different conditions including endometriosis, polycystic ovary syndrome, et cetera. And then the last part is our brain, which is what you started this question with.

Our gut-brain connection.

Our gut-brain connection. And we can unpack this to describe the multiple ways that those microbes are communicating to our brain. But the bottom line is that your brain clearly has a best friend, and its best friend is your gut. And they're talking to each other like teenage girls all day long. They're just on the phone nonstop or texting all day long, and the brain is taking signals from your gut and adapting to them. But it goes both ways because the brain is sending signals back to the gut, which can affect the way that we digest our food.

Wow. So can you have a healthy brain if you have an unhealthy gut?

I think that the healthiest, to have the healthiest brain possible, it is essential to have a healthy gut.

Really?

Yeah. I think that we need to be quite intentional about the way that we go about these things because we can kind of just stumble into our health or we can wake up and see that here we are and we have 38 trillion microbes. They're constantly evolving and changing. The food that you eat today will change your microbiome by tomorrow. And with those choices, you are shaping the microbiome, and that microbiome will affect health throughout your entire body, including your brain, including your ability to function, including your ability to maintain memories, including your ability to focus and get stuff done, and your long-term cognitive health, which includes things like Alzheimer's and things of this variety.

Wow. So if someone is feeling like they have symptoms of some type of mental health challenge. They're feeling maybe they have ADHD or they have depression or depressed thoughts or they have anxiety or stress or overwhelm. What are three things they could do to start recognizing how to fix them?

Well, I'll give you three things and they all connect back to the microbiome. I would start with food. The food is our most powerful lever that we can pull. in terms of shaping and changing the microbiome. And there are simple choices that anyone can make. And this doesn't have to fall under a dietary pattern or a label. It's just changing the way you eat.

What would be for that first one, what would be the top five foods that everyone should eat daily to optimize their gut microbiome?

Okay, I can give you a top five, but can I start with this essential rule, which is diversity of plants. All right, so eating as much variety of different plants in our diet, we have to be intentional about this if this is what we want. Because the problem is the food system is not going to do that for us. You go into the supermarket, they've distilled it down to 75% of the calories in our supermarket is three foods.

What are those three foods?

Wheat, corn and soy.

Wow.

Yes, that is 75% of the calories in the supermarket. Now granted, most of those are ultra processed. Right, so I'm here to advocate for real food. Fruits, vegetables, whole grains, seeds, nuts, and legumes, that's at least five. We could add mushrooms, all right, those are broad categories. And we can get more specific if we want to, but to me it's about getting that variety. And this is not just an idea or a concept, this is actually scientifically proven. So in a study called the American Gut Project, which by the way was international, but it was run out of UC San Diego, What they found is that at the end of the day, when they did their analysis above everything else, there was this one rule. The diversity of plants in your diet was the number one factor in predicting who had the healthiest gut. And the number is 30. 30 per week. 30 different plants. Per week. Now, all fruits, vegetables, whole grain, seeds, nuts, and legumes.

Include those 30.

They count. Okay. All of them, right?

So you wanna have 30 different ingredients every week of plants. At least.

Wow.

At least. But you know what? I don't even know if I've tried.

30 different plants in my life.

Loose.

It's like.

You and I need to spend more time together.

Exactly, right? It's like 30.

Wow, that's incredible. You start it, take a smoothie. It could be Monday morning. Ah. Okay. Take a smoothie, bananas. Blueberries, greens of your choice, whatever ones you like. Chia seeds, hemp seeds. Chia seeds, hemp seeds, flax seeds. We're already up to six. Okay.

Right?

You want to add in some raspberries or some other kinds of berries? We could easily get this up to 10. Gotcha, gotcha. You're making pasta sauce. Why would you just do pasta sauce? Why not throw some plants in there? Oh, there you go. Right? Onions, garlic. basil, oregano, those count too. Spices count.

Why is the, you know, if someone's like, listen, I just like my five to 10 plants a week. I eat healthy plants, I eat mostly plants, I eat non-processed foods. Is that good enough or is it really more about the adding more and more of the diversity as possible as opposed to just broccoli and spinach by itself?

The average person in the United States, 10% of their calories comes from actual plants. The number one plant is the potato. Right? We're not talking about optimal nutrition here. There's a reason why people in the United States are suffering through the health-related issues that they currently have. We need to make changes. If we simply added more fiber to our diet, we would radically transform the health of this country.

Really?

Yes. And that person who's not necessarily eating a lot of variety, but is eating a lot of plants, number one, I give them a standing ovation. Their diet's great starting point. They're way better off than the average American is right now. We all though should be looking to optimize. We all have opportunities to do better. So if you take that diet and you add more variety to it, they will reap the rewards of that. And the reason why is because every single one of these plants has unique properties that are number one going to affect our microbiome. So these microbes, they're kind of like us in many ways, Louis. They have personalities. Some of them are not nice. They have clicks. They have certain ones that they tend to hang out with and they work together. They also have taste buds. They have different food preferences. Not every microbe, believe it or not, likes kale.

Right, but you can train it to like kale or you can get rid of the ones that don't like kale, I guess.

You can train it to like kale, but there's going to be a lot of microbes that are going to be hungry. If the only thing that you ate was kale.

Interesting.

Right? So every single plant is feeding certain families of microbes.

Interesting. So the more diverse and expansive that you have with your plant diversity, the less hungry you'll be as well is what I'm hearing.

Oh, 100%.

So if I just eat broccoli and spinach and kale a few times a week versus I might never feel like I'm full. It's like I still want more. So I need some different carbs or some snacks or things to feel more full. I'm hearing you say it right. If you have more diversity of plants more frequently, you're going to feel more satiated. You're going to get the fiber that your body needs to be less hungry as well.

Yeah. So satiation, feeling full, is an important concept these days. We have all seen the rollout of Ozempic and these other GLP-1 type agonists. What is this GLP-1 that we're talking about here? This is a hormone. It's a gut hormone already produced by your body and makes you feel full. Now, I'm not sitting here and going to try to pretend that what you eat is going to have the same effect on your body that a drug does. That's not what I'm trying to do here. But I want people to understand that here we exist where 95% of Americans, 95%, are deficient in fiber. This is our most prevalent nutritional deficiency. And fiber is what actually leads to the release of GLP-1.

GLP-1 is what exactly?

GLP-1 is glucagon-like peptide-1, which is a gut hormone, which is what Ozempic is. Ozempic is GLP-1. Okay. And it has these different effects on our body, including helping us to control our blood sugar and making us feel full.

Interesting.

Which is the reason why Ozempic is used for diabetes and for weight loss.

When someone takes an external drug like Ozempic to create a chemical, I guess, formulation inside of the body, the brain, the gut, the nervous system, things like that, to either turn on or turn off certain things, how effective is that versus, you know, having 30 plants a week and just eating the foods that will make you feel, that will turn on these hormones that you're talking about that the drug would do? and make you feel more satiated in a full by itself.

So.

First of all, we have to fully acknowledge that these drugs are highly effective. Like there is no doubt that they work.

They're getting results.

They're getting results.

But what are the long-term effects of these?

We have no clue. Right. We have no clue. We don't have the data yet to say what the long-term results of these are. What we do know with complete clarity is that if you stop using the drug, by the way, they're very expensive. they're very expensive, thousands of dollars per month. Wow, right? And are we ready to commit to doing this for the rest of our lives? Because when you come off of the drug, you go right back to where you were before. Really? Yes, you rebound immediately. So flip side though, I think it's important at the same time as we're having this conversation about Ozempic and these types of weight loss drugs, again, I'm not here to vilify them, okay? But when we're doing that, instead of.

Changing the way that we eat, the behaviors.

Right. The problem that exists with this is like, yes, we can measure weight loss. And when people lose weight, there are different things that can certainly improve and they become more healthy. But is the only thing that matters for human health our weight? That is not the case. There is so much more to us as humans and our determinants of our health beyond just whether or not we're obese, skinny, or what our body habitus is. And so we need to look at that bigger picture. The bigger picture is that when we optimize our diet, we have opportunities to improve ourselves metabolically, which includes improving our weight, which includes improving our blood sugar control, but we also have opportunities to prevent other diseases far beyond what Ozempic is capable of preventing.

But also sounds like, as I'm hearing you talk about this, it sounds like if someone's taking something like Ozempic to lose weight, if that's their main goal, like I want to lose weight, I want to take this drug, it's going to help me be less hungry. but if someone's losing weight but they're just still eating processed foods and they're not having plants and they're just eating less junk but they're still eating junk, how will that affect the brain and the gut connection to feeling good beyond just losing the weight?

So the data are clear that when we consume an ultra-processed diet, which in the United States today 60% of calories are ultra-processed foods, so more than half, these are foods by the way that did not exist 100 years ago.

Crazy.

Right, so what we're describing was not possible for our great grandparents. There's no way they could have ate the diet that we currently eat because these foods did not exist. And our kids, 70% of calories in our kids come from ultra processed foods.

Wow.

And there's no doubt that they cause a shift in the microbiome. It's a shift towards what we call dysbiosis, So it's the opposite of what we see when we eat a diverse diet. Diverse diet leads to a diverse microbiome, and that is a healthy microbiome. When we shift towards ultra-processed foods, we're actually contracting the microbiome. We're empowering the ones that love sugar.

We're empowering the ones that create inflammation. And they're signaling the direction they want to go in. They want you to go in. Hey, you want more of this sugary drink.

You want more candy. You want more chips.

They're telling your brain, you need this.

There are interesting studies to suggest that our taste buds and our cravings are driven by our microbiome.

Wow. It's almost like we don't have control sometimes. Or maybe it's felt in the past like, I want this so bad. Yes, I can stop myself, but my desires and cravings are just like, I'm gonna go to the store and buy candy right now. And is that the microbiome kind of signaling and constantly telling us, get this, go buy this, you need this?

I think that they play a role in that hole. Yes, I think that they play a role in that whole impulse. And yes, that certainly exists. But also the beautiful and exciting thing is our taste buds can change, right? Those impulses can change and you can get yourself to a place where what you crave is actually something that's good for your body and nourishes your body.

How long would you say it takes to change your taste buds from not craving sugar and processed foods into craving a diverse plant-based healthy options.

I think it really, you really start to see the benefits of four weeks. Four weeks.

Yeah.

Of doing it consistently.

Of doing it consistently. Yeah. But by the way, I don't recommend that people try to flip a switch. Now there are some people that works for it, but like to me, we want, what I want is sustainable. Right? Something that you can actually stick with. Not extremes. Not extreme. We don't want yo-yo. We don't want to be swinging all over the place.

Right?

So we want consistency, sustainability, and we want it to taste good.

Yes.

So start with the stuff that you enjoy, introduce simple sustainable choices, and build from there.

Mm-.

Right?

And as we start to build, we start to build momentum, and our microbiome is given a chance to change with us.

Wow.

So I say four weeks is what it takes to really make this huge change, but really I would rather that you do it over the course of six months, a year, because then by consistently doing this, you are actually gonna completely reshape your microbiome.

Wow.

So getting back to the question about, ultra-processed foods and brain health. What you're going to create with these ultra-processed foods is an inflammatory microbiome. And inflammation is an essential feature that exists in many different cognitive disorders and mood disorders, including depression, including anxiety.

So from my perspective, inflammation influences anxiety and depression.

Oh, 100%.

How much would you say, sorry to cut you off there, but how many, what's the percentage of the human population would you say has an inflamed gut and brain?

Oh, gosh. It's hard to put an exact number on that. But I think what we see if we were to zoom out, even in.

America then, maybe- yeah, in America.

If we just focus on what's happening here in the States, if you zoom out for a moment, think of all of the digestive disorders that exist.

So, obesity, digestive disorders.

Metabolic issues, immune issues, meaning autoimmune type issues that are like hugely on the rise. Hormonal issues.

Right.

And you go down the line and you think of these things, and I haven't even gotten to the brain yet.

Heart issues.

Basically what I'm saying is the gut microbiome is a player in all of these different conditions. So if the gut microbiome is a player in these conditions and you have these conditions present, you've already proven. You've already proven what the state of the microbiome is. And then the question is, how is it affecting your brain? And could you have better energy, better focus, better ability to do tedious, hard things during the day? And the answer would be yes. And the way that that starts is by changing your diet.

Wow. So the number one thing you said is food. We covered some of these foods.

Yes. And 30 different plants.

30 different plants. Yeah. What are the next two things? We talked about the top three things.

So on food, real quick before we move on, there's a study called the Smiles Trial.

Okay.

Where they took a plants predominant, it was not vegan, it was a plants predominant Mediterranean diet.

So it has some fish and shellfish, things like that.

100% and it was as effective as medication for the treatment of major depression.

Really?

Yeah.

Just putting them on that nutritional food plan. For some reason, I don't like the word diet because I feel like it's a restriction as opposed to an addition. which is what we're talking about. It's not about eating less and starving yourself. I think that's what people associate the word diet to. It's like starvation, cutting out all foods that I enjoy and being miserable. That's what people think when they think of diet. And so, I'd like to try to keep correcting myself to be like, what's the healthy food plan? What's the nutritional abundance plan that we're going to step into?

Abundance is the right word for what we're talking about here. 30 different plants or more. I'm asking you to add more variety, not take away, not restrict. So it's the opposite of what we've been told by traditional fad diets.

Yes.

So, all right, number two.

Yes.

So we want to improve our mood. Okay, exercise. So exercise clearly improves our mood, can be used as something to help in the treatment of major depression. And the question is, how is it doing that? And one of the answers to that question is actually through the way that exercise shapes our microbiome.

How do they shape our microbiome?

It depends on what exercise you're doing.

Okay.

So what kind of exercise do you like? I'm curious.

I like to lift really heavy.

Me too.

And I like to run about two to three miles. I ran four miles last night, but I usually run two and a half to three at about a seven mile hour pace.

Cool.

So not too intense, not like too slow, but kind of like a steady pace.

Yeah. Do you switch up your exercise every once in a while to see if you can get better gains?

I daily do different sets and different kind of like body parts, I guess, but I'm constantly following a program to either intensify or add reps around weights.

Yeah.

So I'm getting more gains. In fact, I just put up 220. I haven't done 225 in years, but I started like six months ago, maybe four months ago, being like, how many can I do? And I did three.

Yeah.

It's like, okay, let me see what I could do over the next few months. And a couple weeks ago I did 11 and a half reps at 225. So I feel like I'm back at almost college when I did 15 when I was training football.

Yeah.

And I feel like I could do more than that now that I have more wisdom and knowledge and nutritional and training and recovery information.

So it's amazing to be in your 40s and thriving. Yes. And that's. And I'm actually lifting my heaviest weight in my 40s as well. Yeah, dude, let's go. Yeah, dude, I'm pumped. Let's go.

Get the cameras and let's go lift right now. Exactly. So, I like to play pickleball. I want to make sure I'm doing like some athletic movements also. Not just like I'm on a bar, I'm jogging on a treadmill, but it's like, okay, I need to do some pickleball. I like to do ping pong. I like to do different activities. I like to dance salsa. So, I'm also making sure that I'm doing lateral movements, not just in the gym, because I know how important that is for mobility, stretching, all these different things.

Ice tub, sauna, like I'm incorporating as many diverse activities as possible. Well, this is the point, and I don't know that you were intentionally trying to set me up there because we haven't talked about this before, but actually diversity of exercise. is actually a relevant idea.

Really?

Yes. So much we could be talking about different types of foods have a different effect on our microbiome, different exercises have a different effect on our microbiome. They did this study where they looked at marathon runners and they identified that there was this one bacteria called Villonella that was disproportionately represented within these marathon runners. So the scientists, this was by the way done, I believe, at Harvard in Boston. The scientists asked the question, What's the deal with this velonella? Like, why would the runners have more this specific thing? And the answer was quite interesting. The velonella was breaking down lactic acid. When we run endurance exercise, lactic acid accumulates in our muscles. That creates muscle fatigue. If you want to be a better runner and have greater endurance, you would break down lactic acid. The microbes are helping.

That's interesting.

They have another study done by rugby players in Ireland. And they looked at their microbiome, these rugby players, and they discovered that there was a shift within their microbiome towards actually more anti-inflammatory bacteria that interact with fiber to produce what are called short-chain fatty acids, which are the most anti-inflammatory molecules out there. and these short-chain fatty acids, which people may have heard of them, butyrate, acetate, propionate. These short-chain fatty acids have healing effects right there in your gut. They help to shape the microbiome. They affect the immune system. They affect our metabolism. And they enter the bloodstream and they travel all the way to the brain and they affect the brain, including the blood-brain barrier.

That's interesting because playing football growing up in high school and college, I always felt like I healed very quickly. I felt like I would, like when I get a scrape or a cut or I'd get like a bruise, like it wouldn't really show. And I don't know if that was because I was training in a certain way that was explosive and power and speed that my microbiome, I guess, were helping me recover faster. I have no idea.

Yeah.

Like a rugby player.

I don't know. Well, it's interesting because you think about all the great athletes, for example, in the NFL, and you see these guys do, you know, like Adrian Peterson comes to mind. where some of the recoveries that he had during his career. That was crazy. Were crazy. And they defy the rules of recovery.

Yes.

And it makes you wonder if there's something.

Genetics, is that microbiome?

Is that, yeah. Are there other factors in play here? But what's interesting is because you have this shift in the microbiome towards these anti-inflammatory molecules. Okay, well, I just mentioned that depression has an inflammatory component to it, right? So here we are and we discover that exercise is actually good for helping our mood. And what I'm saying is what's happening under the hood, if you lift up the hood and take a look, is there's this shift in the microbiome. And now you don't even have to change your diet. I mean, I do want you to eat more plants. Right, right.

But exercise alone helps you improve your anxiety or stress or depression.

Yes, and that shift that's happening in the microbiome is actually helping you to get more from your fiber. so you don't change your diet, you eat the same fiber, now you get more from it. But what if you also changed your diet at the same time that you were implementing this exercise?

We did one and two, food and exercise.

This is why they synergize so well.

So would you say your gut microbiome influenced your mood more than anything else?

I think that the answer is yes. And the reason why I say that is they have these bizarre studies that they've done where they take people and they inject into them something called lipopolysaccharide. What is that? All right, lipopolysaccharide is produced by bacteria that live inside of us, like E. Coli. So we've all heard of E. Coli, okay?

So this is like, they inject a.

Disease inside of us. So they're injecting this thing that you find in E. Coli into a person's bloodstream. And then they track them over the next couple of hours. We're talking about humans, we're not talking about mice right now. and they see what happens and here's what they find. Number one, because this bacteria has entered into the bloodstream, they get increased levels of inflammation in the body. Number two, their mood and their motivation to work dips.

Wow.

All right. Number three, they socially withdraw. All right, so what's going on here? Basically what I've just told you is that when they inject this E. Coli type stuff, which I, by the way, want to unpack that in a quick moment, When they inject this E. Coli based stuff called the lipopolysaccharide, it basically activates inflammation, which affects their mood, and it also makes them socially withdrawn. And they think that what's happening is that the body is starting to shut down to preserve energy because it needs to fight the infection. So that's number one.

It's going to slow itself down. It's not going to have the energy to talk to people or be motivated.

100%. and then they socially withdraw. Why would they socially withdraw? We're social creatures. We come from living in tribes of people, right? And you want to protect one another. If you're sick, you don't want to pass that on to someone else. So when you feel sick, there's this natural inclination to socially withdraw to get away.

Interesting.

To protect the others.

Now, is this injection through this study, is that causation or is it, I guess, correlation? I guess, what is it, the difference between like, did it cause them the microbiome to be depressed or is it part of the correlation of it? It could be something else that is causing that.

Okay, so we have these studies where there's correlation. You have a group of people with major depression and you study their microbiome and you discover that their microbiome is damaged.

Yes.

Okay, they have what we call dysbiosis or a leaky gut. Right? Now, what's causing what? That's the question, right? Because there's a correlation, but you can't prove that the microbiome caused the depression, or similarly, you can't prove that depression caused the microbiome change.

Yes.

Right? So then it raises the question, how do we then prove this? And there's a couple of ways that you prove this through interventions. And when you take this lipo polysaccharide, Basically what you're recreating is what happens when a person has a damaged gut.

Interesting.

Because when you have a damaged gut, those microbes, they live inside the tube of the intestine. And as we discussed at the very beginning of the show, that tube is outside of our body. We have a single layer of cells called the gut epithelium that basically protect us. Because on the other side of the epithelial layer, is 60 to 70% of our immune cells.

Wow.

Okay? So the immune system is there to protect us on the other side, and the single layer cells, it's like the wall of our castle. And when our gut breaks down, when our microbes are damaged, when we don't have enough anti-inflammatory short-chain fatty acids, you start to see this gut barrier breakdown. We get what people may call leaky gut, and what leaks, is the lipopolysaccharide. This lipopolysaccharide that they were injecting in this study, basically what they were recreating, they were not recreating an infection. They were recreating chronic inflammation.

Interesting.

That comes from a damaged gut.

Wow. So when you have inflammation because your gut is out of whack or is not healthy, it's gonna cause you in some ways to feel lower energy, anxiety, depression or some type of, I guess, symptom that doesn't cause you to be.

Your best self, is what I'm saying. 100. And I think that these, these can exist on an entire spectrum.

Right.

This could be a bad day.

Yes.

Right. But it could also be something that is more chronic and clinical, such as major depression.

Yes.

And, like, for me personally, This is where my personal journey started was that I was in a bad place with my own health.

Really?

And one of the issues that I had was I was depressed.

Really?

Yeah. And I just wanted to be by myself.

And this is when you were in medical school before or after?

So, I was in my gastroenterology training. I was in the University of North Carolina Chapel Hill. If you looked at me on paper, you thought that everything was perfect. Yet, there I was laying under a blanket in a dark room watching Reality television.

Like all of us do when we're depressed. It's like, I've been there. I've been there. Wow.

Below deck, baby.

Below deck, that was your drug of choice.

So this was when?

How many years ago was this? This was 12 years ago.

12 years ago.

So you're in medical school.

I was in, so I graduated medical school in 2006. So we're talking about roughly 2012 now.

Okay.

So I was a board-certified internal medicine doctor. I'd finished my internal medicine training. was the chief resident Northwestern. Wow. And then I moved on to the University of North Carolina. I was on a grant from the NIH and I was studying both at the School of Public Health, which is like one of the top three schools of public health in the country. I was doing that and working during the day as a gastrologist in the hospital. And I was miserable. Wow. And, and my life was in a bad place. I also had high blood pressure, high cholesterol. From a mood perspective, tons of anxiety, high levels of depression. Again, like I just wanted to lay in a dark room by myself under a blanket and be left alone. That's all I want to do.

But you had made it. You were at the top of your field. You were an expert. You were, you know, leading a hospital in that department. So why do you think you were sick even though you were a doctor?

All I know is this, that I did not want my own medicine. in that moment?

Oh.

The things you were prescribing to others.

The things that was prescribed to others and that I had been trained by great doctors to do. I didn't want that in that moment.

Wow.

And so the tables had turned. Now I'm the patient. And I needed something to help me. And I tried to exercise my way out of this.

So I'm gonna work out harder.

I'm a type A.

Right, right.

So I go hard.

Obsess.

Oh.

Hardcore.

45 minutes of weight training a day.

HIIT. Cardio, yeah.

Jump on the treadmill either a five or a 10K or jump in the pool because I was in North Carolina and do 100 laps.

Dang, that's intense. Yes. It's triathlon training.

I grew stronger or faster or whatever athletic measure you want, but I still felt unwell. Really?

Maybe you felt a little bit better.

But felt a little bit better, but I really felt unwell.

And you had a big gut.

I had a big gut.

Really?

Yeah.

Yeah.

And, and I needed something to change and the Weird and bizarre thing about it is that I grew up, I come from a humble place in upstate New York and I was raised on junk food.

Yeah.

And this is the way I ate for 75% of my life. And the food that was glorified in our house, how could that possibly be the cause of my problems?

The food that brought us love and connection and intimacy and fun and play.

Oh, yeah. Get home from school. Play some hoops or Mario Kart, fire up the grill, couple dogs, right? Like every game.

Yeah, summer barbecues. Let's go.

It was fun and I loved it, but it caught up to me.

Wow.

I caught up to me in my early 30s. And so I needed something to change. And the thing that changed for me was that I eventually looked in the mirror. It was actually by meeting my wife, who like here we are, you know, More than 10 years later, we have four kids together, but in this moment we're going on our first date and she ate very differently than me.

Really?

Yeah.

And I've never seen anything like that.

How does she eat?

We were at, so we were in, you know, North Carolina. Yeah, right.

They didn't have all the diversity back then.

No. Of foods. Well, and you look at the menu and my wife said to the waiter, she pulled him aside and she goes, Can you get me a plate? And on that plate put collards and black-eyed peas and okra and some mashed potatoes. Wow. All right. And so she had them arrange a plant plate. And I was like, who are you?

Yeah, yeah.

What is going on?

I get some steak or chicken or.

Yeah, I got my usual pork chop. So look, I'm not saying that's wrong. What I'm saying is that my diet needed an overhaul. There needed to be changes. And seeing that, she opened my mind. Because she looked amazing. She looked amazing. She seemed to be healthy, have everything going for her, and it seemed to be effortless. And here I am grinding out an hour and a half of exercise every day.

With a gut still.

With a gut still. Wow.

Right?

What is going on?

Why'd she go on a date with you? So, I have no clue.

I have no clue. The sun shines on the dogs, you know? So anyway, and it just, but it was enough to open my mind. And so there was this one day where I was gonna go to Hardees and get my usual $5 deal where they can get you like 2,500 calories for five bucks.

So bad.

You know, for about two seconds you feel great.

Then you feel sick.

And then you just want to get on some sweats and lay on the couch. Oh, make weird noises.

Yeah, yeah, yeah.

So anyway, instead, I went home. Look, I'm a single guy in my 30s. I am not going to cook a gourmet meal.

Right.

Right. So I pulled out a blender and I threw a bunch of stuff in there, and that worked. And I made, like, a 40 ounce smoothie, and I instantly felt like something that had been missing from my life was in that. In that cup.

And.

And it made me, you know, I don't know if you've ever experienced this, but when. you feel really unwell. You just want to feel better.

Yes.

And so that made me feel better. And when, when that happens, it's enough to make you say, well, I want to feel that way again. And so I came back the next day and I did it again. And that started the process for me of changing my diet. And once I started to change my diet, the weight melted off my body.

Really?

My confidence, because I had extremely low self-esteem But you were in the top.

Of your field as a medical doctor and GI and running a hospital division and...

Didn't matter. All the degrees and... You could shower me with the degrees and the awards and all these things and I felt good for a day and then I went back to feeling like trash.

Why do you think you felt so insecure or low self-esteem?

I think that the way that we feel about ourselves is affected by what's going on inside of us.

Really?

Yeah, I do.

Wow.

I absolutely do. I think it's more than just like there are labels that we can apply whether or not a person has a clinical condition, major depression, generalized anxiety disorder, whatever you want it to be. But there are also aspects of who we are that are very human that maybe we don't have a label to apply to it, but we all experience it. And that is self-esteem and that is energy levels and things of this variety. And I was in a dark place. And so anyway, making that change completely radically transformed my health. And because I had that moment, I'm a medical doctor and I care a lot. And so I felt like I have no choice. I have to bring this into the clinic. And so I started bringing this into the clinic to treat my patients. And I saw radical transformations among people with irritable bowel syndrome and acid reflux and Crohn's disease and ulcerative colitis. I see these radical transformations. And you get to a point, I eventually got to a point in 2016 where I was like, this story, like people deserve to hear this. And it should not be pre-required that you come to see Dr. B as your doctor in order to hear this story. You should be able to hear this no matter where you are. And that's what motivated me to get out there and start doing this. Wow, man.

Do you think it's possible for us to have high self-esteem, high positive energy, without exercising and eating only processed foods.

I think you'll be so such a fraction of the person that you could be if you were to start to make those implement those changes. Wow. Yeah, absolutely.

We've only talked about food and exercise first. What's the third thing?

All right, cool. So I want to start by saying this. There are these 12 nerves in the brain called the cranial nerves. And if you actually look, as I did in Gross Anatomy in medical school, at the skull, clearly we have evolved to really protect these nerves. They come from our brain and they pass through these special sort of channels within the skull and they basically control everything that really matters. So our ability to see one another, Our ability to smell, to hear, to taste, to move our tongue, to talk, to swallow, right?

Like this is- 12 nerves impact everything.

Impact everything. But there's this one nerve among the 12 that's like, Dude, what are you doing here? It's like the black swan. Because 11 of the 12 are just involving basically the brain and the upper neck. But there's this one nerve that breaks off, travels from the brain all the way through the chest, all the way down into the abdomen.

The brain comes down. Well, I mean, the nerve comes down.

The nerve comes down. And it's connected.

This one nerve, not all 12.

No, no, only one out of 12. Right, so when you think about how important these nerves are, clearly, like these are our priority nerves. And here's this one nerve, that has come down to connect to our gut. And this is called the vagus nerve. And the vagus nerve is absorbing information. It is sensing what is happening within our gut, with our immune system, and communicating that back to our brain. And this is one of the ways, I mentioned earlier in the show, that the gut has multiple ways to communicate to the brain. We've actually started to cover several of them. One of them is with short chain fatty acids, another is through the vagus nerve. All right? So these are two of the ways that our gut communicates to our brain. The vagus nerve is fascinating because there's new technology that's coming out now that shows us that you can actually just activate the vagus nerve and change the way that a person functions.

Really?

So they call it A vagal nerve stimulator. It's an implanted device. You need surgery in order to have this. And it sends an electrical signal through the vagus nerve.

And it goes back to the brain.

And it goes back to the brain. And by doing this, you can improve a person's recovery after stroke. You can reduce their exposure to debilitating diseases like epilepsy.

Wow.

And it's FDA approved for major depression.

Holy cow.

Yeah. It's now being studied in irritable bowel syndrome, Crohn's disease, and ulcerative colitis. So now we're studying these things in digestive health conditions, not just cognitive conditions, because the vagus nerve affects both. Okay. So the vagus nerve is quite fascinating. We have the ability using a technique that's completely free and every single listener can apply this to their own life right now to control the vagus nerve in a number of ways. And the one that I'm here to advocate for is breathing. So deep breathing exercises affect the vagus nerve.

All right.

The way that we do this is to take four seconds in through the nose and then to release for six seconds through per, pursed lips. All right, so you actually are going to be forcing air on some level because you got six seconds of release.

Slowing it down a little bit on the way out. So, this is a 10 second longer on the way out. Yep. So, it's not box breathing, but it's a... Not a complete box. Yeah, yeah. Okay. So, you're not holding at the top.

Breathing out longer than holding at the bottom. You're just breathing in and out longer. You know, different studies look at different variations on basically the same thing. It always seems to be something on the order of four seconds in and at least four seconds out. Uh-huh. Right? So, I'm... talking about six seconds out just because of this one study that we have to cite. A little longer, yeah. Yeah. But if you do four seconds in, four seconds out, you're good.

You'll be better than most of us breathing through our chest, one second in, one second out, only in the chest and not deep, intentional, slow, fully oxygenating the body, the brain, everything, right? All of that, and then activating the vagus nerve.

That's what we're getting at. That's what we're getting at.

Interesting.

Yes. So we're talking about activating the vagus nerve. by doing this. And you can do this every day. And if you do it for literally 10 minutes, literally 10 minutes, you will notice differences as you start to do this day by day.

So if you just do this for 10 minutes a day, just breathing to activate the vagus nerve, what type of improvements can you see?

Okay. So we talked about the vagus nerve is this information superhighway connecting our gut to our brain. So we would expect to see improvements in both, am I right? Yes. Okay. So number one, I'm of course interested in pooping. Yes. Because that's what I work for.

Right?

So I want people to poop and I want them to have great bowel movements. And in one particular study, they took people that had irritable bowel syndrome with constipation. So they were constipated people. And they had them do this exercise on a daily basis. And what they discovered is that it actually radically transformed their bowel motility All right, their intestines were moving differently and they pooped more frequently. So they actually had relief from their constipation, not by changing their diet, not by taking a laxative, but by breathing. That was it. That was it.

No exercise, no different foods, no dieting, nothing. Just breathing. Just breathing. They pooped better.

They pooped better. Now, if you exercise, you'll poop even better. If you eat fiber, you'll poop a hell of a lot better. But it's amazing to think, just ponder that the power that simply by a breathing exercise, we can alter the physiology of our intestinal system.

That's incredible.

But we can also affect our brain.

And this is backed by studies and science and research.

We can post it to the show notes.

Yeah, that's amazing.

We can also change the way that our brain works. So, by doing this type of breathing, we can improve our Focus, improve our memory, improve our cognition, and improve our mood. Wow.

This is incredible. I do want to talk about. So these are the top three things we can do to improve our mood, food, exercise, breathing, along with all the things you said within each three, which I think are powerful. And I know there's a lot more to it, but that's a great Baseline. I do want to talk to you, since we talked about poop. How many times should we be pooping a day?

Let's just get right to it. I'm just curious. My wife has told me that I'm far too comfortable talking about this topic. Sometimes we're at dinner parties and it's.

Like, yeah, this is how you should be pooping and how it should look.

Yeah, yeah, yeah. She's like, you,'re not allowed to talk.

About bloody bowel movements anymore.

Oh my God.

So wait a minute. First off, how many times should we be pooping a day? And how long does it take for after you eat food for it to come out? What's the optimal timeline to know that you're a healthy, functioning human being?

I'm so glad that you asked this question because actually there's a fun experiment that people can do at home. So now, first of all, let me answer the question about pooping.

Yes.

I'm of the belief that pooping should be a it should feel full. There should be a complete evacuation. All right? There should be a complete evacuation. You should no longer feel like you have to go when you're done. It should be satisfying. And this entire process, dare I say, should be fun. Like it should feel good.

It shouldn't be painful.

It certainly should not be painful. It should not be effort. It should feel good. And you should be able to flip that door open and strut out in slow motion. And Michael Buble, I'm feeling good, is blasting. While like explosions and smoke.

Yeah, explosions and smoke.

All right, this is the way that I think it should be for people. Unfortunately, it's not. Shocking, considering 95% of Americans are fiber deficient. Of course, that plays a role. How often should we poop? The average American poops once a day. If you were consuming an adequate diet with an adequate amount of fiber, you would be pooping more than once a day. Really? Oh, definitely. You would poop probably twice a day. But it's not about the number. So I want to make sure that we not fixate on this because I'm quite sure There will be listeners who will hear this and they'll go, Something's wrong with me if my wife wants to have sex. Yeah, hold up. If you are pooping on a level where you have complete adequate bowel movements, it's satisfying. You have a sense of relief when you're done and you are not suffering symptoms as a result of your bowel movements, you're in a great place. And that maybe that's not once a day for you. And that's okay. All right. So there are people who poop every other day and I would not classify them as constipated. based upon that alone. Meanwhile, Louis, there are people who poop every day and they are clearly constipated.

Yeah.

And unfortunately, they don't even realize that they're constipated because they say, I'm pooping every day. You need better bowel movements. If you are not completely evacuating when you go, then that is not it. Then that is, to me, the first step towards backing up and backing up is constipation.

Wow. How long should it take when you get on the toilet? To finish. Should it be like, okay, I sit down, it should be like 30 seconds done, I wipe it clean and move out, or is it like okay to be there for a few minutes?

So for the dudes in the audience, I'm quite sure that many of you have a habit of bringing your phone into the bathroom and checking your fantasy league or whatever it may be or playing a video game, and I don't want you spending more than five minutes on the toilet if you can avoid it. So the process of pooping should be where we feel a sense of urge, not necessarily urgency, but urge.

Like, I need to go.

I gotta go.

I can hold it if I need to, but it's time.

It's time.

Right.

And in that moment, you are listening to the cues of your body, right? This is completely natural. And you go into the bathroom, you get into a proper pooping position, which by the way, a proper pooping position is not sitting rigidly on a toilet.

What is it?

It's moving your feet up. So having some sort of- oh, I've got that. You have a Squatty Potty?

Oh yeah, do you? I love it, man.

Yes!

I love the Squatty Potty, man.

I've had that for a few years. Oh, you're a pooping master.

You're a pooping icon. I don't know about that. I think the reason I got it is because I used to be constipated. I used to be like blocked up, right?

Yeah.

I don't know if this is TMI here, but- Certainly not moving. And I want to ask you this. for probably, I don't know, 15, 20 years. Like it was not every day, but it seemed like it was off and on, right? It's like, oh man, I'm taking a while to go. It's like, you know, and here's when it started to change. So what you're telling me at the beginning of this conversation is starting to make some sense. And I started to pull some of this together in the last couple of years too. I'm curious about, When I was 16, I had eight teeth removed. The orthodontist was like, you,'ve got a small mouth, we gotta open your mouth, we gotta give you braces, but we gotta take out the four wisdom and.

Then four on the sides.

Oh, that's brutal.

Right?

Yeah.

It was miserable for weeks. Four weeks of recovery with just ice bags and a freaking helmet to hold it together, right? It was miserable. Now as it started to heal, I was just like, I don't want to go through more pain. I was 16. yeah. Football season was coming up. I was gonna wear a mouth guard for three months. I was like, I'll wait till basketball season to put the braces on. I delayed it as long as I could. You know, three months turned into 20 years where my teeth started to enclose. I. I couldn't. My back teeth stopped touching, so I only could touch my front two teeth right here, the back teeth. like enclosed, it like went reverse my jaw so the back teeth did not touch. So I wasn't able to chew properly. So it would get very tiring chewing with my front two teeth. So it essentially just eat a few bites and swallow. So one, I finally got Invisalign and got braces and I finally got implants of those teeth so that could actually chomp my food better. Once I got those implants in, I still have one more to do. Once I got them in, I noticed that I started to use the bathroom better. I was able to chew more fully, chomp more fully, and therefore process better. I was also more intentional about how I was eating and what I was eating and things like that. But I'm curious if you're just chewing a few bites and swallowing your food as opposed to actually chewing it down, how that affects your I guess blocked up or constipation levels. And adding that with a processed diet, I'm assuming, did not support me with my gut.

Right. Yeah, there's multiple different factors there. It's interesting what you're describing with your teeth because this is what a lot of older people deal with on a routine basis.

Really?

Yeah. And they struggle to be able to chew their food. And because they can't chew their food, they opt for simpler foods that are pre digested in a way, which are ultra-processed foods. It's a lot easier to eat ultra-processed foods. There's quite a bit of data actually around eating rate, how fast we eat. By the way, this is something that we're looking at at Zoe. Zoe is a company that we are running the world's largest nutrition science study right now and I'm the US medical director. And so with eating rate, how fast you eat, it's highly compelling. that foods that require us to slow down actually are beneficial to our metabolism.

Interesting.

Yeah.

And you could take the exact same food and serve it two different ways, one of which you can just scarf down or the other one requires you to actually chew your food and the one that requires you to chew your food that's less pre-digested actually is better for your body metabolically.

Really?

Yeah. So what about smoothie versus?

What about a smoothie?

In a perfect world, in a perfect world, you would eat a salad. You want to make it smoothie, you're going to make it smoothie. But I'm here advocating for smoothies because they're delicious and they're a great way to still get fiber, phytochemicals, polyphenols into your diet with a diversity of plants. And then you can have your salad for lunch.

You're not going to even sell it at every meal. Yeah, yeah, exactly. Wow.

So you're saying nut butter versus almonds? It's better down the almonds. 100%.

Why is that?

I think there's a couple things. So part of it is the food itself. It's not like food is more than just calories and nutrients and macros. There's a structure to the food. And we call it the food matrix. And an intact food matrix is, generally speaking, the preferred way to consume our food. So basically what that means is less processed. Wow.

Yeah.

So, even if it's like a whole food, but it's pureed or processed, right, or crushed down or whatever it might be, it's better to have the whole food by itself than the processed version or the crushed down version.

When possible, but I'm not here to make it sound like I don't like almond butter or peanut butter. There have been some interesting studies about if you take the exact same food and you cook it, if you cook it, it actually has a different effect on the microbiome. So, for example, you take kale and maybe you would steam the kale to soften it up and things like this. By steaming it, you're actually changing the food a little bit. It's not a bad thing. And it'll have a slightly different effect on your gut microbiome than that raw, uncooked kale. So, there's a lot of interesting stuff there.

What is more effective or more efficient, the raw, uncooked vegetables or cooked /steamed/ sauteed vegetables.

Well, I think when people are changing their diet, it's better to give your gut an opportunity to adapt and to gently ease into it. And cooked food or smoothies, things that are kind of broken down already, they're a lot easier to digest than the raw foods are. So going raw food only to me, I don't really advocate for that. Hardly. Yeah. All right, so bowel movements.

Yes.

So I prefer for people to have a natural bowel movement in five minutes or less. You shouldn't have to strain to go in a perfect world. It should come out quite naturally. You get your business done, you get up, you walk out the door. Don't sit there. Don't sit there because blood gets pulled down into your pelvis when you're sitting there in that position, and it actually fills the hemorrhoids. And we have an epidemic. I mean, I hate to say this. I feel like we've been talking about a lot. epidemics here today. We have an epidemic of hemorrhoidal issues.

What is hemorrhoids?

Hemorrhoids are the most attractive concept out there. So these are basically like veins that carry blood and they exist right around our bottom. Now, I know I should have an answer for why did we evolve to have hemorrhoids? And I do not. I don't honestly know why we evolved to have hemorrhoids, but we did. They're there. All right? And when our bowel movements change, whether that be constipation or diarrhea or straining to go and bearing down and pushing, we are actually driving blood down into these beds of tissue, these hemorrhoids, and they get engorged, they get enlarged, and then they can cause trouble. So they can cause bleeding, they can pop out, they can itch. So there's a number of different things and statistically 50% of Americans who are age 50 have hemorrhoidal issues.

So, can you heal those hemorrhoids?

You can make dietary changes that will certainly improve them substantially because they ebb and flow a little bit. So maybe they wouldn't be completely non-problematic because they are a part of our anatomy. So when you change the anatomy and you have an issue there, It's on some level there to stay until you do something surgically to fix it. So, but anyway, so that's the reason to not spend too much time on the toilet.

So, if someone is having one of those three, I guess you said diarrhea, constipation, and straining. Straining, like you need to push through the go, right? If they're experiencing that occasionally or frequently, what are the main causes of those three styles of unhealthy pooping?

This is a huge conversation.

I mean, like, it might take a day to hold it all in.

Yeah, well, I have courses that are multi-hour courses that I've taught on each of those topics. But if we were to say, okay, let's bring it back to, what is the thing you can do? And the answer is fiber. Fiber. Because the power of fiber, again, 95% of Americans are deficient in fiber. What's unique and special about fiber, one of its superpowers beyond feeding and fueling our gut microbiome, to create short-chain fatty acids is that it's the only thing that I'm aware of that can fix both diarrhea and constipation, fiber, and bring it back to the middle. So it gives your stool form, it gives you that glorious soft but formed bowel movement that we're striving towards. And when it's soft and formed, then it comes out a lot easier. You don't have to strain to go. So we are addressing all of the issues that you just described.

So what do you have? when you have hard, when you have.

Hard poop or see you blushing just.

A little or you have, I guess, I don't know what the word would be like, not continuous or it's like just loose, loose or it comes out.

Yeah. Yeah.

What does that mean? Does this mean you don't have fiber? If you have like really hard poop or like it's not continuous.

What we do know is this. Actually, it brings me back to a question that you asked earlier, which is how long should it take for us to poop?

Yes.

Right? If it's faster, that's typically associated with loose stool, like diarrhea, because you have faster transit as you're moving through.

Yes.

And when it's slower, that's associated with constipation. And both of these things are actually associated with changes in the microbiome. So the microbiome is a player for sure. in our gut motility and whether or not we develop diarrhea or constipation. And we can actually do a simple at home exercise to measure this and determine what our gut transit time is. And that is, so we at Zoe, this is actually a study that we published in one of the top gastroenterology journals on the planet called the Gut. And basically what we did is we had people eat blue muffins. And these blue muffins the food dye will show up in your poop.

So you can see when it comes out.

So you can see when it comes out. How long?

So you time it.

You time it.

Yes.

And most people are like either they're pooping 24 hours later or 36 hours later or up to 48 hours later. And all that is normal.

Okay.

All that is normal. But if you see that blue in less than 18 hours, you got fast transit and typically you're going to have diarrhea. And that's actually that's not good. We don't want that. Okay.

So that's a lack of fiber.

Many times that's a lack of fiber. Or you may see very slow transit where it's coming out like more than two days later, right?

And that's not good either.

That's not good either. So all of these things are actually correlated not just to our microbiome, because they are, but they're also correlated to metabolic parameters. So like for example, there's this thing that we use as physicians to predict a person's risk of cardiovascular disease like heart attack. And so this is like a 10-year risk score. And believe it or not, like your bowel transit time in this study was correlated to your cardiovascular risk. Wow. So it's worth us paying attention to these things.

So having healthy poop is a huge part of living a healthy life.

I think so. And I think that the thing that's interesting about about poop is that we ignore it. We ignore it because it's like we've stigmatized it. But if as a gastrorologist, you look at your poop every time? Most of the time.

Yeah, yeah, yeah. I guess.

Kind of proud. Kind of proud. We're in a good place. That's good.

Yeah.

Well, it's important to pay attention, I guess. This is the key.

You have to be there at it, but it's like, it's important to be like, you have to be creepy. Okay, yeah, I mean, flush. See it as it goes down and, all right, I'm doing the right things.

You don't have to be creepy about.

It and you have to obsess about it, but you should take a look.

You're not putting your hand in there and checking it out. You're not doing weird stuff. Please don't do weird stuff. But I do think it's worthwhile to take a look and understand where you're at. And there are these seven different measures of stool called the Bristol Stool Score. Interesting. Okay, so and they're individual pictures that allow you to see like what hey, my poop looks like this.

All right?

And some of them are diarrhea and some of them are constipation and some of them are right in the middle where you want to be. That's a Bristol 4. Bristol 4 is the fantastic glorious bowel movement. Okay. Okay. So, and the thing that's key from my perspective, because this correlates to our gut microbiome. And if it correlates to our gut microbiome, then it also correlates to our digestive health, our metabolic health, our immune health, our cognitive health. because of this, we should be looking at this. So I think it's important for people to know so you can at least know, hey, is this not a Bristol four? Is this a Bristol one or two, which is constipation? Is this a six or seven, which is super loose and watery, which is diarrhea? Because if that's where you are, then we need to make some changes in order to get you to a better place.

And a lot of it comes down to adding more fiber to your diet.

If you add more fiber to diet for the vast majority of people, they will actually see substantial improvements in terms of those bowl issues.

Wow.

Now, I don't want to sit here. Like, there are people that have, you know, some sort of medical issue.

Sure.

It's more complicated in those people. So let's not make it too simple here.

Right, right, right. Wow. Fiber. Fiber is one of the keys, it sounds like. Now, how do you know what are the. I guess what are the main symptoms.

Of having a leaking gut? Well, we've started to touch on this. Yeah. So a leaking gut again, it comes back to this single layer of cells, the epithelial layer. and when it's breaking down, it's because of things that are happening within the microbiome. And it's creating opportunity for things to get into the bloodstream or across into the immune system that aren't supposed to be there. When a person has a leaky gut, it can be a number of things, but I think the first thing you're gonna feel is a loss of energy. We saw this in the lipopolysaccharide study where they injected the lipopolysaccharide into their blood. They felt fatigued, right? That was within a couple hours. So low energy is one of the key signs. And I think the reason why this is, Louis, is because energy is this thing that we all experience. I do, you do. I could ask you right now what your energy level is, zero to 10. You'd have an answer for me for sure.

Yeah.

Right, and so would everyone else. Yet doctors don't get it. Doctors don't understand. You go to your doctor, say, I'm feeling low energy, I'm feeling fatigued, and they kind of roll their eyes. And the reason why is because I don't think they mean to dismiss you. I actually think they're very compassionate. They just don't know what to do with that. and what I'm saying to you and what I want people to hear is that this is because it's connected to our immune system and inflammation. There's overwhelming evidence that this is true. So right now, if you look at a group of people, 20% of people will tell you in the United States that they have low energy and they have tons of fatigue. Okay, 20%. But if you were to look at a group of people that go to their doctor, It's one in three instead of one in five. One in three people that go to the doctor have low energy. If you look at people that have a chronic inflammatory condition, it's at least one in two. It's at least 50%. But if you were to look at autoimmune diseases, which are like overt, rip-roaring chronic inflammation, among autoimmune diseases like Crohn's disease, ulcerative colitis, MS, multiple sclerosis, It's like almost 100% of people will tell you that they have low energy. Wow. Right? So to me, energy is we're pretending or the traditional medical system has pretended that it's meaningless. We don't know what that means. And I'm here telling you that there's now overwhelming evidence that this is a measure of our inflammation.

Wow. Now, we've been talking about the gut health with the immune system, but how does gut health plan with the nervous system?

And impact it.

It gets back to the gut-brain connection. We've touched on two different ways that the gut connects to the brain. One is for chain fatty acids, the vagus nerve. Okay, so let's look at some of the other ways. One is neurotransmitters. So neurotransmitters are things like serotonin. Serotonin is the happy hormone.

Yes.

When we treat major depression or generalized anxiety disorder, we use serotonin reuptake inhibitors. to boost serotonin levels in the brain. It turns out that 95% of serotonin is produced not in your brain, in your gut.

Come on. But everyone talks about serotonin in the brain.

Yeah.

But it's produced in the gut.

95% of it is produced in the gut. 5% of it is produced in the brain. Now, in the brain, it is very relevant and important for how we feel our mood, our energy levels, our focus. But in the gut, the microbes have the ability to actually shape the production of serotonin and serotonin precursors. And these serotonin precursors affect bowel motility and affect mood and can cross the blood-brain barrier. So if you think about this, people that have, for example, irritable bowel syndrome, all right, so what is irritable bowel syndrome? There's no, here we are, it's 2024, we don't have a blood test, we don't have a CAT scan or anything we can do to diagnose this condition. We've known about it for 50 years. Okay, what is going on here? Well, they have a change in bowel motility, they all have either diarrhea or constipation, they all have abdominal pain, and in an overwhelming fashion, they suffer from mood disorders. There is a massive disproportionate prevalence of depression, anxiety, and other mood disorders in people that have IBS. And it's quite fascinating because when you think about it, it connects back to the gut and the brain and the new way of thinking about this condition, which has changed many times during my career.

Really?

Yeah.

Yeah.

About thinking about and treating IBS.

Treating IBS, right?

Wow.

Now there's a more holistic view, which is a good thing.

Not just say here's a drug or here's this thing.

Yes.

To say it's not just a digestive disorder, this is a disorder of the brain and gut axis. Interesting.

Yeah.

Because I've heard about people struggling to go to the restroom from different times if they feel unsafe, if they feel like maybe they're, in an unhealthy relationship and it's causing certain gut issues. Is that connected to the nervous system not feeling safe because of the environment or relationships that are out of alignment? Does that impact the digestive inner workings as well? You know, is that all play in 100? Really?

100.

Do you think IBS is more of an emotional challenge then?

I think it's a disorder of the brain gut axis.

Interesting.

I think it's more than just one or the other. It's both. So we have to incorporate both in that, in our concept of that. But start with a simple example. Person's about to go on stage and give a speech. They have anxiety around that. What do they do? They feel flutter in their stomach, start to feel nausea, maybe it builds towards cramping abdominal pain. and maybe they have to run to the restroom and go. Wow.

Right?

When I was in medical school on test day, there's like a line out the bathroom door. It was disgusting.

Right before when I played football, man, I had to go like five, 10 minutes before the game started.

Yeah.

It was like, you try to go an hour before to get it done, but then, like, just the nerves or the excitement would just be like, I gotta go now. Yeah.

Right before, like, we're starting the game, I'm like, I gotta go. Let's describe exactly what's happening there. So basically what's happening there. this is once again the brain-gut connection. Now, the brain is taking center stage instead of the gut. The gut becomes secondary. And the stress of the moment leads to activation of the sympathetic nervous system. Wow. The sympathetic nervous system is the opposite of what we were describing with the vagus nerve. The vagus nerve is our parasympathetic. That's our rest and digest. Relaxed state. The sympathetic is I'm about to run into a football field and try to knock someone's head off, right? so you're getting charged up for a fight or to run away from a saber-toothed tiger or whatever it may be. That's our sympathetic nervous system. The brain, as a part of that stress response, there are good things that happen. You get an adrenaline surge, you feel powerful, you can in that moment do superhuman things, but there's a sacrifice, and the sacrifice is your gut. The brain releases a hormone called corticotropin-releasing hormone, or CRH. and the CRH sets off this inflammatory cascade. And downstream, if you follow that, ultimately what you discover is it has a negative impact on the gut microbiome. It affects bowel motility. It also actually directly affects the microbes. So there's a shift within the microbiome. And then here we are and you gotta go to the bathroom. Wow.

You would think that in a fight or flight moment that your body would suck it in so you could actually run away, right? Get away from the moment.

Some people do. Some people get very constipated under stress. But basically what we're talking about though is an acute stress, an acute stress, which is different from a chronic stress. What do you do if you've been exposed to trauma? And it lives in your unconscious mind and it causes you chronic stress on a daily basis because you have not healed that wound. that emotional wound.

What happens?

People get IBS and Crohn's disease and ulcerative colitis. And I've had many patients.

You got two?

A hundred percent. Wow. Because what I'm giving you are the diagnoses, but the root cause is a damaged gut with leaky gut.

So the symptoms or the diagnoses, I guess, are the damaged gut. But the root of that is a lack of healing and emotional trauma.

I've had many patients. These are actually my proudest moments as a doctor, to be completely honest with you. My proudest moments are not getting people to change their diet. My proudest moments are taking that person who has been to six or seven doctors and they're not getting better even with medication and you build a doctor-patient relationship. It's not one visit, talking about four, five, six visits, and you get to a place where they tell you something. from their past that is still affecting them today. And my role as the doctor is not to fix that specific issue, it's to bring awareness to them so that they understand that these are not separate issues. Wow. And once they discover that, then actually treatment is like next level because they actually turn their attention towards the thing that they've been avoiding or ignoring. They turn towards that. and they have a healthcare professional, not me, that's not what I do, but they have a healthcare professional who helps them to heal that wound. And when they heal that wound, these are people that have been doing 30 different plants, exercising, deep breathing exercises.

They're still not everything. Their gut is still messed up.

Gut's still not messed up. Dr. B, I've done everything your book tells me to do. I'm still messed up. Okay, once we discover this, the healing.

Is a rocket ship. It's like within a days, it's like transforms.

They are completely transformed because they're doing because everything is right. But it's like that rocket ship is chained down. Wow. It's chained down. So it's trying to go off, but it can't go off because of these chains and you got to break the chains, the chains that are holding them back. And that is their that is their history of trauma.

Man, isn't this fascinating that you could do all the right things physically, but if you don't heal emotionally or psychologically, and allow your nervous system to feel safe, you can't take off as a human being.

100%.

That is fascinating. And that's why I just believe that learning to face yourself and address the emotional, psychological or memory wounds that you're holding on to and processing those things that can take time and healing those things emotionally will set you free physically as well.

I think this is the missing piece that a lot of people haven't heard and they need to hear.

Wow. It's almost like doctors, if they had also training on therapy, you know, how to implement that type of process. I guess you couldn't be trained therapists with some type of training. It's almost like that could also elevate healing better.

I am a believer in a teams-based approach to healing. that there's not going to be that.

One person that can do everything.

One person that does everything anymore. That you need to surround yourself with a team of competent people that you trust and you have faith in.

Gosh.

And work with them. But it's the, I want to give a quick shout out to one of my mentors at the University of North Carolina. His name is Doug Drossman and he is the founder of irritable bowel syndrome. So he wrote the book. It's called the Rome Foundation. And basically it was like a group of scientists that met in Rome, Italy for the first time and put together this idea of what IBS is back in the 80s. So that was Rome 1 and they've gone through and I think they're on Rome 4 now. So basically, but he's the author. He's the guy that has organized this and led this, created this diagnosis. I worked in his clinic. The hospital hated us. We would see two patients in half of a day. Most gastroenterologists these days see two patients in 15 minutes.

Really?

Yeah.

We would see two patients in a half of a day. We would spend hours with these people, but these were the people that I'm describing that would bounce from doctor to doctor and never get better, and the system was failing them. Because you can't just use a pill for everything. Wow. You can't just make a diagnosis and fix everything. At some point, someone needs to have a holistic view. and see the complete person and see that we are more than just this one set of symptoms. And that's what we did. And he was quite interesting because he was a professor of both medicine and psychiatry, and I would call him a maverick because he's back there in the 80s and 90s and coming up and making connections, for example, history of sexual abuse. in childhood, connecting that to the manifestation of digestive disease as an adult.

Wow. I mean, that's something I talked about on this show many times about dealing with sexual abuse as a five-year-old and how it left me feeling very unsafe and clinched a lot and kind of like always looking out to see who was going to try to attack me, abuse me, take advantage of me in different social settings. Even when I want to be a sexual abuse setting, but just a setting of like, school setting, right? Sports, whatever it might be. And I believe that was a big part. Four or five years ago, I started really diving in deeper on sexual abuse healing. I started about 11 years ago but didn't fix the teeth and I still ate poorly as well. But, I started to kind of put it all together four or five years ago with fixing teeth, intentional eating, eating healthier, healing trauma on a deeper level. And I feel like it's allowed me to have more freedom within my body as well, peace and harmony. Someone asked me this morning, how are you feeling today at the gym? How are you feeling? And I had another guest on earlier today where I told him I always tell people the truth about how they're feeling. So if I'm not feeling good, I'm like, man, I'm messed up right now. I'm stressed out. I'm this. Like, I'm honest with how I'm feeling. I don't just say good for every answer. And I said, I'm feeling peaceful, loved, abundant, grateful, and harmonious. And it's how I feel.

Sounds amazing.

But it's been willing to face incredible amounts of pain within myself, address it not just once and be done, but consistently for the last four and a half years.

Yeah.

Almost weekly. and being willing to face it and process the pain to create meaning, to process shame, guilt, insecurity, and whatever else I was holding on to psychologically, emotionally, physically, from the different traumas of life, and allowing myself to self-love without shame anymore. And it has been one of the most challenging processes I've ever had to experience, but the most liberating and freeing process. And it's a journey that will continue. I feel better, my gut has reacted better, and I only feel like I can improve from here as well and continue to get better. So I'm so glad that you, as an expert in this field, as a doctor, medical doctor, talking about healing the emotional traumas. can sometimes be the final thing that allows us to elevate our physical potential as well.

It's people like you that have the ability to change the lives of millions of people because you sit here and you speak with openness about a difficult topic for you and that requires courage and putting yourself out there. I appreciate that you do that. And there's an interesting thing that you said just a moment ago that I can't help but put comments on real quick. which is that you talked about feeling like tensed up.

-Clinched. -Clinched, yeah.

-Is the word you used, right? -It's actually not a coincidence that constipation is actually the manifestation in many cases of that kind of trauma because that feeling of clinched actually like you truly are.

-Yeah, constantly. -I mean, I constantly was. I don't attach that to myself anymore. But in my years growing up, in my teens and my early 20s, it was a clenched feeling. It was almost like I was ready to fight at all times. It was like waiting for someone, wanting to trust and love the world, but waiting for someone to take advantage of me at the same time. And it wasn't a relaxed state of being. How can you trust when you're a.

Five-Year-Old who's vulnerable and exposed to something like that? That's really hard. And as an adult, we're constantly struggling to overcome those types of experiences that we have. But I just find it interesting that the words like this, like clinched, you're intending it figuratively, but it actually is literal.

It is literal. It is, Lynn, it caused digestive pain. You know, it was hard to go to the bathroom.

This is what I'm saying.

Sitting there for 20, 30 minutes at times, you know, being like, how am I gonna get this out? You know, it's just like, but like you said, going back to the breathing, like just activating the breathing alone for 10 minutes a day will allow you to relax your mind, your nervous system, your body, and connect it, your gut as well, so that you can process everything better. You add the exercise, you add the food. But I feel like the fourth thing, what I'm hearing you say, I don't know if this would be the fourth thing, would be healing emotional wounds, healing trauma. and you could do the first three food, exercise, and breathing, but it sounds like a lot of your patients, until they healed the trauma, they still struggled with their gut.

Yeah, I don't think this is everyone, yes, but for people that have something in your past that you're still struggling with, and maybe you've repressed it, right? Maybe you're not thinking about it, but it's there. If you have something like that, I just want to bring awareness to the fact that this is not something that you're able to hide and put away to the side, it's continuing to affect you. And to be the best version of yourself, the best thing that you can do is reach out for help and address it directly.

Wow. This is beautiful, man. I got so many other questions on my list that I would like to ask you, but I think a lot of these things are probably in one of your books. And you've got so much content as well. I want people to check out. your website. What is the main place that we should send people to to learn about your books, your programs, your information?

So yeah, you can find me on social media. So I'm the Gut Health MD.

Yes.

You can come to my website, which is theplantfedgut.com, I'm quite proud of my email newsletter. We have a large community and basically like I, my favorite way of communicating is not on social media. It's through your newsletter? It's through my newsletter. Because then I can like really attack and break down studies the way that I like doing it. I'm signing up. So thank you, dude. And then the other thing is that I mentioned this a few times, but I think I should bring attention to this. So I'm the US medical director of Zoe. Zoe is running the world's largest nutritional sciences study. Basically, if you were to sign up, we send you a kit. It has a microbiome test, a continuous glucose measure, and a blood fat test. And we combine all those factors to give you a personalized dietary plan. And I'm actually very proud of the fact that, first of all, Zoe, we ran a randomized controlled trial, and the results are going to be published in Nature Medicine. I don't know exactly when it depends on when the show airs.

Sure, sure.

But that's literally the top journal on the planet. That journal never takes randomized controlled trials. I think the reason why they took ours is because this is a groundbreaking study. But nonetheless, we're honored.

What did the study reveal?

Well, so people were randomized. So it's a clinical trial, and people in the United States were randomized to either do the Zoe program or US dietary guidelines. Now, US Dietary Guidelines, if you go and you look at it, I mean, people can find stuff that they disagree with, right? We can all find stuff. But if you actually follow it, most.

Of it is sensible advice.

What's the main philosophy of it? Oh, we want you to consume enough fiber. We want you to add more fruits and vegetables to your diet right now. Yeah, yeah, yeah. So, I mean, there's stuff in there that I may disagree with, but the.

Majority of it, I'm gonna sit here and say, you know what? You've got probably 80% of it right.

Sometimes Grandma said, Finish your pie, you know? So, you know.

That's because she loved you.

That's because she loved you. It wasn't because she was worried about your health. Exactly. and she wanted you to love her back.

Exactly.

Yeah, yeah. So, but anyway, so, so we're not comparing to like eating croutons.

Yeah.

Right. We're comparing to an actual real diet that is recommended by our government. And so in this study, people that were on the Zoe program, first of all, by simply doing the Zoe program for 18 weeks, they, they lost multiple centimeters off their waist.

Right.

They reduced their visceral fat. They lost weight. they lowered their triglycerides, they improved their gut microbiome. And then I think the part that I want to talk about, because it's relevant to this whole conversation that you and I have been having here today, is that they had more energy substantially, substantially more energy, better mood, they slept better, and it improved their hunger. So in other words, they were able to control their appetite.

Yeah.

Okay. So they got all of these benefits, but then the cool part is people that were the most compliant with our program. Meaning like there's some people that don't do it. Yeah. Right? But if you actually do it, what happens? You get everything that I just described yet intensified. You get even more. So like you double the number of centimeters off your waist by actually doing the program. But then you also start to reduce cardiovascular risk factors. You lower your blood pressure, your ApoB, your LDL cholesterol, Now here's the part that I think got Nature Medicine excited. I think this is the reason, I'm about to tell you the reason why I think they published our paper. We looked at the people who are most compliant with Zoe versus people who are most compliant with the government guidelines. Like do you actually follow the advice? Yes. Right? So now it's not an excuse of oh, I didn't do it. Now it's like are you actually doing it? And when we compared those two things, Zoe dominated. So in other words, this personalized plan that is Specific to you. It's not the same for everyone.

Interesting.

Outperformed what our government considers to be our ideal diet.

Which is kind of do this for everyone.

Yeah.

Do this for everyone.

So Zoe kind of takes these three different measurements and tells you, here's what your body, your gut, your blood, your genetics, here's what you should be doing for you.

Yeah, we break down.

It'll be different for someone else.

100%. You could, you could, you could do it with, if you have a sibling, you have a brother.

I've got three older siblings, yeah.

Brother and two sisters. So hypothetically, if y'all did this, what you would discover is that you're different. A big part of your difference is your microbiome. Your microbiome is completely unique to you. There's no one on the planet with a microbiome yours. So you might share some more genetics, but your response to food is different because you have all these other factors that are different. And we can see that. So we can look at your blood sugar, your blood fat, your microbiome, We can give you that feedback and we can also empower you with an understanding of your food. There's no food that's off limits. This is not about restriction. This is about abundance. So it's about understanding though your food and how to properly eat for your own unique biology. That to me is exciting.

Wow. So anyway, how can people get access to this or try this?

If you want to check it out, go to zoe.com slash will be. The reason why I put slash will be there is because you'll find a sweet little gift from me, which is a 10% off ticket.

Nice.

And you can use that little code to save a little cash if you decide to go for it.

Amazing.

We have a podcast too, by the way.

I've seen it, yeah, it's in the top of the charts in the health section. I see that. Yes. It's always competing with me.

I'm trying to get ahead of that all the time, you know? Well, you have an amazing diverse podcast. I love what you do. And we are science-oriented. Science-oriented. Yes, exclusively.

With a heavy focus on nutrition, but a lot of other things. That's great. And so people can check that out too. Now, you guys are doing awesome. Zoe.com slash will be also the plant fed gut.com check that out plant the gut health MD on Instagram, Facebook and social media. This is powerful stuff, man. And I feel like the more knowledge and wisdom we have around this information, this science, and the more we can just start testing a little bit of it, trying some of it today and seeing how it impacts our mood, our health, our wellbeing, it's just going to make us better human beings. So I'm so grateful and I want to acknowledge you, Will, for dedicating the last 20 years of your life to understanding this and expanding your knowledge and doing all the studies and the research, but also taking a big risk and a leap of faith when you got sick, I guess, 10-12 years ago and saying, hey, let me see if there's other information I can gain outside of my medical training. Let me try new things. Let me try to take this from our first principles approach. Let me try to see if there's other ways that I can heal myself first so that I can help others heal as well.

Yeah.

So I want to acknowledge you for that, man, because I think there's a lot of people that are sick today like you talked about. And unfortunately, unless people get this information from you or from other people like yourself who are teaching this, people are going to be very sick over the next five to 10, 20 years. and it's going to take big wake up calls for them until they make a change. So I hope people are able to spread this message and share this with a friend today and help anyone, even if it doesn't seem like someone is unhealthy physically, send them this episode on video or audio to get people educated, informed on how to be healthier and impact the people in their life more. So it just feels like people are sicker now more than ever.

Closing thought?

Yes.

That sounds very pessimistic.

I get it.

And I understand that people would feel that way. I'm very optimistic. That's good. Here's why. Because there's a revolution taking place in science. We didn't know anything about this microbiome stuff until now. Now we have the ability to not just look at it, now we can manipulate it. We're proving that, for example, with the Zoe study that I just mentioned, the randomized controlled trial. We have the power to manipulate it. The choices that you make today will have an effect on your microbiome by tomorrow. So for the listeners at home, be optimistic that you can make a small choice. And these small choices may seem trivial in the moment, but guess what? If you were to come back and do that again tomorrow and the next day, this actually small choice will become a massive and powerful choice for your health. Don't wait until you have a problem, do it now.

That's incredible, man. I want to ask you two final questions. Dr. B, one is, I call it the three truths. so imagine a hypothetical scenario. You get to live as long as you want, but it's your last day on Earth, and you get to see your family grow up, have a beautiful life, continue to create in science and research and write more books and speak and whatever you want to do, you get to live your life fully. But it's the last day. And for whatever reason, in this hypothetical scenario, you have to take all of.

Your work with you.

Every conversation that is recorded is gone. Every book, every podcast, every post, anything you've ever published, it's gone. We don't have access to your information anymore. But on your final day, you get to leave behind three lessons to the world, three truths that would be your truths. What would be those for you?

So I'm gonna start with the obvious one from this episode, which is increase your fiber intake and add 30 different plants to your diet. All right, so let's get that out of the way and we don't need to talk about that anymore because I want to move into the part that I'm excited about, which is number two, to invest into human connection. I think it's so important. And number three, make sure that you make time for your family and the people that you love. So, because at the end of the day, all these things, the money is seductive, it's attractive, but it's love, it's relationships, it's family that really are what make us feel full.

Final question, what's your definition of greatness?

Thriving in everything you do.

I hope today's episode inspired you on your journey towards greatness. Make sure to check out the show notes in the description for a rundown of today's show with all the important links. And if you want weekly exclusive bonus episodes with me as well as ad free listening experience. Make sure to subscribe to our Greatness Plus Channel on Apple podcast. If you enjoyed this, please share it with a friend over on social media or text a friend. Leave us a review over on Apple podcast and let me know what you learned over on our social media channels at Lewis house. I really love hearing the feedback from you and it helps us continue to make the show better. And if you want more from our world-class guests and content to learn how to improve the quality of your life, then make sure to sign up for the Greatness Newsletter and get it delivered right to your inbox over at greatness.com/newsletter. And if no one has told you today, I want to remind you that you are loved, you are worthy, and you matter. And now it's time to go out there and do something great.