Heal Leaky Gut, with Dr. Vincent Pedre

Hello, and welcome to this episode of the Five Journeys podcast Live like youe Matter. I'm Dr. Wendy Trubo. This is Dr. Ed Levitan. And our guest today is Dr. Vincent Pedry. He is the founder of Dr. Pedri Wellness, CEO, founder of Happy Gut Life. And his newest book, the Gut Smart Protocol, is the culmination of years of research and clinical experience as a functional gut health expert. Welcome.

Thanks for having me. What a pleasure.

Very excited to have you and very excited to talk about one of our favorite subjects, which is the gut.

It all starts in the gut. Your volume's not as good as mine. Just for the record. Normally I would say that that's like just a, you know, because I'm talking louder, but we can't hear you as well. We want to hear what you have to say. All right, that's much better.

Okay, there you go.

Moving right along. How'd you get into it? Like, is this personal or like, how'd you get into the gut? Why there?

Yeah, it's, it, it is a personal journey. And, and it's kind of crazy because I, I, I had a book in me for a very long time, and, and I didn't know what that book was going to be, but I had a lot of book ideas and they never quite caught on. And when I finally zeroed in on a book about the gut, it all made sense. Because you felt it in your gut? Well, yeah. I had been on antibiotics two or three times a year, starting at age 10, all the way through the end of my teenage years. So by the end of my teenage years, I had been on 20 plus rounds of antibiotics. And I didn't know that. When I was in college, I actually started gaining weight. I went from being an overweight preteen to losing all this weight, becoming super skinny, being made fun of, and body shamed for being too skinny. And then I get into college and I'm eating in the dining hall was an all you can eat, and I'm eating tons of bread and, and having pies for dessert. And I started gaining weight and I thought, wow, this is great. I finally am filling in. But looking back, I had kind of like that doughy face that you get when you have gluten sensitivity. And I didn't realize that that was the reason my gut had become leaky. My microbiome was decimated, and I had developed sensitivities to gluten and dairy and actually was one of my inspirations, aside from my passion for science and helping people, but my own personal reason for becoming a doctor was to hack how I could not get sick because no one understood. And the pediatricians thought, well, you're too thin. You're not eating enough. But I calculated I ate over 3000 calories a day as a teenager. I was having a milkshake for a snack after school every day. My mom would stop at either. I think it was Burger King, and we would get a vanilla milkshake on the way home. I mean, talk about, like, I was having cereal with milk for breakfast. I was having sandwiches at lunch. I was having a milkshake every day after school. And no wonder my immune system was going haywire, right?

No, you're talking to a celiac.

So, yeah, do you have celiac? That was my next question.

I don't, actually. I've tested negative for celiac, but I do light up for gluten reactions. So I'm one of those non celiac gluten sensitive people.

Do you have the genes? Do you know if you have DQ2 or DQ8?

I don't. I don't. Although it's interesting because, I mean, you know, we probably don't know all the genetics. And a lot of people from Ireland have that right. And my grandmother was from Spain, from Northern Spain, from Galicia, which, if you go historically back, that area of Spain was invaded by the Celtics from Ireland. And my grandmother actually had blue eyes, which is very rare, you know, in Latin families. And so maybe there is some sort of genetics through there. What really got me into this was. I mean, by the time I was in residency, they were feeding us pizza with soda for lunch during our lunchtime lectures. And within an hour, I was running to the bathroom, and I had no idea. I thought, overworked, exhausted. I just don't feel well. You know, my. My energy was horrible, and I didn't really realize what was going on. By then, I kind of knew that I was lactose intolerant, so I was being really careful with dairy. But I still. I still didn't understand the degree of how dedicated you had to be to the diet in order to feel well, you know, because we think, oh, I'll just cut back. You know, I'll just have a little bit, and I'll. I'll be fine. And.

Wait, we gotta talk about that. You just said something really brilliant, Vincent. Because cutting back, for someone who's sensitive, if you cut back as a human, you're thinking, oh, well, I'll eat it once or twice a week instead of every day. But the problem with that level of Exposure is you never get the antibodies down to a place where the repeat exposure shows you how bad it is. You're constantly getting pinged. And so, as humans, when we think of cutting back, it's never enough.

Honestly, it's never enough. And what I tell people is that tablespoon of half and half in your coffee looks small to you, but let's shrink ourselves down to the size of your cells. That tablespoon is pretty big, and it's gargantuan. It's going to have a pretty dramatic impact on how your immune system is reacting. By the time I was done with residency, I was actually getting to a point in my life where I've never been very pro medication, so I wasn't going to be on any IBS medications. But I was still trying to figure out what's going on here and partly just resigning myself to the fact that, hey, this is my matrix. This is the way my body works. My older sister has an iron stomach. She could eat anything and nothing affected her. Meanwhile, I never know, like, eating out. Like, I had no idea. Like, if I ordered polenta, like, why is this not sitting well for me? Like, I thought I was making good choices. And then I discovered functional medicine and realized, wait, the antibiotics I'd been on destroyed my gut microbiome. I developed leaky gut. I developed food sensitivities, and this is reversible. Are you serious? And leaky gut? What is this? Like, I didn't learn this in medical school. This sounds like pseudoscience. And honestly, I was a big skeptic in the beginning. But even with the skepticism, I decided, you know what? I'm going to test for these things. And I did a food sensitivity test with complement activation and found that I lit up quite strongly for gluten. And part of my motivation was my mom had been diagnosed with rheumatoid arthritis, and my older sister has multiple sclerosis. And I was learning about the connection between the gut and autoimmunity. I'm in my early 30s and thinking I need to change something here, because I'm looking down the timeline, and I'm worried that I'm going to develop an autoimmune disorder as well.

Let's go to the gut. What actually does it mean to have a healthy gut?

Well, first of all, it means that your gut is producing all the right amount of enzymes and very importantly, hydrochloric acid in the stomach. Because a lot of people are walking around with low stomach acid, either because they're highly stressed and their Vagus nerve is shut off, so they're not getting those signals to turn on that acid production. And two, because the second most prescribed medication worldwide are proton pump inhibitors that basically raise your stomach pH to 4 or 5, which is not a good PH to digest and break down protein. So having adequate enzyme production, having a healthy pancreas, having a healthy bile production and bio really high bar.

Vincent, you've already set the bar too high for.

I know I'm setting the bar really high. And then, and then having a gut barrier that is permeable, but not too permeable, you know, because our gut barrier is meant to allow things to come through, but you don't want to let inflammatory substances enter the body. And a lot of people are walking around with leaky gut. I think it's hard to, to figure out how many people are. But when you start thinking about all of the ramifications of leaky gut and all of the, the gut related health issues that can happen in the rest of the body because of leaky gut, you have to think that probably at least 80% of the world population is walking around with some level of, of leaky gut.

I think we need to dive into this because when you think about. So I am a celiac and so this is one of my passion plays too, so you're talking my language. I don't think that people realize that when you are someone who has one or both of the celiac genes, which is DQ2 or DQ8, and about 40% of the population has one or both, one or the other or both, that you have higher levels of this weird, weirdly named receptor called Cxcr3. When the body sees the particles of gluten, it binds to them, you have more of them, you upregulate zonulin production. And zonulin is the first discovered substance that causes your tight junctions to open, in essence causing leaky gut. Anyone who has the gene and eats gluten causes that to happen for up to four hours at a time. When you go back to your teenage years when you were eating cereal for breakfast, sandwich for lunch, and you were causing leaky gut, the whole pasta for dinner, I was like, did I remember properly? And so what you create is a scenario where you have leaky gut the whole day that's caused by the food we're eating. Now if you don't have the genes, you open your tight junctions for about 15 minutes, which is better than four hours, but is still opening your tight junctions, allowing everything from the outside world, bacteria, the toxins, the food particles, the bacteria. I said bacteria twice, those bacteria back.

And I think it's a multi hit hypothesis. So people think, well, I've been fine, so I'll be fine. The oldest patient that I've diagnosed with celiac disease was a woman who was 52 years old and she had autoimmune thyroid. She wasn't feeling well. Her thyroid function was actually, her thyroid was regulated so we had balance of thyroid and still there were things that just her energy was low, she wasn't feeling well. And I said, you know, there's a strong connection between thyroid, autoimmune thyroid and celiac. We need to check your genetics. She's from, her family's from Scotland. So again people from northern uk, from Ireland, they tend to have those genetics.

And, and the Jews and the Irish, the Irish, the Jews, the Italians and then every other country actually has now been shown to have more likely.

But, so, so you know, then I, I, no one had thought about this. And let's go back 20 plus years when I was in medical school. In medical school we were taught that celiac disease is a diagnosis that is made during the early years. It was something that you paid attention in pediatrics and it was caught really early on then. To think that I might have a 52 year old woman being diagnosed with celiac for the first time in her life was mind blowing at the time as I was learning functional medicine and I ran her numbers and I'm pretty sure I'm just going by memory, she was positive for one of the markers, but I sent her for an endoscopy and she had celiac, there was no question. So that's the final goal.

Standard is bone density because she probably didn't have very much of it.

I know, right? Well, the oldest patient I ever had was in her 70s. She got diagnosed in her 70s. You're definitely right. Because if 30%, 40% of the population has the gene, it's not a guarantee that you're going to get celiac. But it means you could get celiac.

Exactly.

Just like if you're female and you have. Yeah, okay, I'm not going to go there.

And I think it's actually, I think it's, it's really important what you said earlier, because there was a study where they looked at, you know, what is the effect of, of gluten on gut permeability on three different groups of people, celiac people with celiac disease, people with non celiac gluten sensitivity, which is estimated. So celiac is what like 1 to 2% of the population, non celiac gluten sensitivity might get that up to 8, 10%. And then everybody else who's normal, and you would think, well, if you're normal and you're not having any reactions when you eat gluten, you're fine. You're not going to have an increase in intestinal permeability. But in this study, they found that they still did. The celiac had the highest increase. The non celiac had the second highest. But the people who were normal and exposed to gluten, it wasn't zero. They had a mild increase. So you have to think that if you keep exposing yourself to gluten, over a lifetime, even if you are normal, if you expose yourself to too much gluten, you're increasing. You're opening that gate every time. And then that, like you said, opens up the floodgates for inflammation in the body. And then the person is wondering, why am I overweight? Why can't I lose weight? Why do I feel tired? Why is my brain foggy? And all these things that you start to attribute to getting older, and you think, well, it's just aging. I'm just getting older. And don't realize that it's actually because your gut and your gut microbiome are completely imbalanced.

Well, I want to actually take us away for a second because you two are glued to the gluten thing, but I really want to make sure that's.

Actually what gluten means in Latin is glue.

Like I said, I'm going to take us away from the gluten thing for a minute. And I want to go back to what you were pointing out before you were on antibiotics. People drink a lot of alcohol these days. People take, like you said, PPIs, a lot of protein pump inhibitors. People take a lot of NSAIDs.

Wait, they're stressed. You skip the stress. Are you getting to that? You can get there a little faster.

I'm taking stuff. So they're taking a lot of pain medicine for ouchies. Ow, my head hurts. That means I have a deficiency in ibuprofen or something of that nature. And yes, the genetics are there. And even if the genetics aren't there, the gluten's there. And that's probably for some people, that might be enough. But for the majority of people, I think that's not enough. I think it's all the other habits we have that are adding to that. Like.

I agree. Yeah, like, I, I, I 100 agree that it's not just One thing, it's the combination of. Of everything. You know, for one, antibiotics.

What's that?

And now you can talk about stress.

Stress and. And stress, because stress is like an attack on the gut, and stress will cause changes in the gut microbiome and then throw the stress in. Usually a person who's stressed is also having a drink because they're stressed, and that's their way to relax. But alcohol itself is an antiseptic. We use alcohol to clean surfaces. We use alcohol to wipe the skin before you do a blood draw. So if you're drinking alcohol, it's actually going to affect your gut microbiome, and then by proxy, it's going to lead to increase in gut permeability and increases in inflammation and secretion of interleukins and all sorts of inflammatory cytokines. And unfortunately, a lot of medications that are over the counter, which people would think, well, they're over the counter, they're approved, they're benign, they're fine. Even acetaminophen. So there was a study I found that showed that acetaminophen causes changes in the gut microbiome that can lead to increase in intestinal permeability. So we used to think, well, acetaminophen is safe. Avoid ibuprofen because it can affect your stomach, can cause ulcer, it can increase gut permeability. But acetaminophen is not quite innocent. And we know it also can cause liver damage.

Well, it depletes the glutathione stores and.

And then you can't detox.

So, yes, there's another thing that's really common, and this is a tough one, because you don't want to have an unwanted pregnancy. But birth control pills also increase gut permeability.

I forgot about that. Ashley, that's a good point.

How would you know if you had leaky gut? I mean, to you and I, it screams. But to someone who's listening, how would they start to map onto their lives that this might be pertinent for them?

Yeah, One thing I did in my book, the Gut Smart Protocol, is I created a quiz with a score. And that score divides people into mild, moderate, or severe. And the more severe the higher your score. Pretty much you have leaky gut. And as a clinician, it's funny, because over the years that I've practiced functional medicine, spoken to my other functional medicine colleagues, colleagues who have been doing it for much longer than I have, and I used to teach for the Institute for Functional Medicine, and it was interesting because you start with wanting to do all these tests. And then where I saw everybody going is like, oh, yeah, I don't really do testing anymore because I just ask a really thorough history and the history tells me what's going on with the patient. And I think that's happened to a lot of us because we noted that we did the testing and we did the history and we just kept finding that the test just basically confirmed what we already knew from speaking with the person. There's no perfect test for intestinal permeability. There's a lactulose mannitol test, but it's not perfect. It picks up increase in intestinal permeability in the small intestine. But you have diseases like Parkinson's where the intestinal permeability increases in the large intestine, not the small intestine. But also you can look at, almost like I think of it like Plato, like looking at the shadows. You're not, not looking directly, but you're using evidence of an immune response to say that there is an increase in intestinal permeability. So you can look at antibodies to zonulin, you can look at antibodies to actin and vinculin, which are cytoskeletal protein structures that are used in the tight junction. So if you have those antibodies, you assume, okay, the tight junctions are getting broken down, the immune system is being exposed to it. But it's not a direct measure of intestinal permeability. It's just an indirect way of looking at it. You can also look at anti lipopolysaccharide, anti lps, endotoxin antibodies, and if they're present again, assume there is increased intestinal permeability. With ibs, there can be anti cytolethal, distending toxin antibodies as well.

Just pause for a minute, Vincent. These are the tests that the providers can run, but as a listener of the podcast, they're not running those tests.

No. When you tell them so what they're going to feel, what they're going to feel is what I call gut related symptoms. So there's gut centric symptoms and there's gut related symptoms. Gut centric. Everybody knows I've got a bellyache, I'm bloated, I'm constipated, I'm gassy. There are symptoms that happen inside your gut, and most likely they're related to a gut issue. Sometimes they're not, but most of them are. The ones that are tricky is when you've got eczema, you've got psoriasis, you're breaking out in hives, you feel fatigued, your joints are achy, your brain is foggy, you have migraines, you get stick often, you get recurrent sinus infections. All these things are signs that you have leaky gut. And the downstream effects of having that increased intestinal permeability is it causes all of these problems in other parts of your body that you would think are unrelated. Even dementia has connections to leaky gut and development of Alzheimer's and all that has connections to the gut microbiome.

Well, isn't it? We're now finding out that leaky gut can be related to leaky brain and all sorts of wonderful things and leaky everything else.

And then. Yeah, I didn't mention that, but depression and anxiety. There was a study that came out in at the end of last year where they had looked at over a thousand people and they looked at their gut microbiome and looked at correlations between those that were depressed and those that weren't. And they found that the gut microbiomes were different. And there were 13 different types of bacteria that were related to depression that were not necessarily found in people that were not depressed. And some of them were. I kind of. I think these names are funny because I think they're almost like Disney villains. One is called Agarthella and another one is Hungatella. And I didn't realize. So when I was researching my book, I had not run into this. I was looking at the connections between the gut and heart disease and through the metabolism of things like L. Carnitine that comes from red meat, or phosphatidylcholine from shellfish and that gets metabolized by gut bacteria into tma, trimethylamine. While Hungatella is one of those bacteria that converts those nutrients into tma. And that TMA then goes through the portal circulation into the liver where it gets converted by another enzyme into tmao. And we were talking about genetics earlier. It's dependent on genetics. So some people are going to be higher converters and some people are going to be lower converters. And of course, then it dep on the balance of your diet. But that tmao, which increases the risk for heart disease and stroke by double regardless of what your baseline cholesterol is. I also, when I was looking at this study on depression, learned that TMAO is also connected to depression as well.

Interesting.

All right, so an asthma.

I want to add in asthma to me as someone has a leaky gut. And it's personal because I stopped having asthma when I stopped Having gluten. And I used to be able to tell I had been exposed because I would have an asthma attack and I'd be like, oh, I must have had.

And I think that's, I think it's important to highlight that because a lot of people out there are walking around with environmental allergies and they'll go to their doctor and they'll give them antihistamine. Again, it's the top down approach versus the bottom up approach. Looking at the root cause and dealing with it from the inside versus the outside. And what really started surprising me when I, when I, you know, really got into functional medicine and started working with people on their gut health is they would come in and tell me, doc, my allergies, I, I don't have allergies this, this spring. And I noted for myself that as I worked on my gut health and I started kind of really refining my approach that my patients would come in and they would be, Their noses would be running, their eyes would be red, and I felt nothing. And you would hear, turn on the news and they're saying it's the worst allergy season in a while. And the only time I would feel it was when it was a mechanical issue. Because if the pollen counts were really high in the air, you get pollen sediment on your eyelids. And so I would feel it in my eyes, my eyes would start to burn a little bit, but otherwise I wouldn't feel anything in my airways. And I saw that with patients and also with breathing issues, with asthma, just taking out food sensitivities, rebalancing the gut microbiome. When you promote a healthy gut microbiome, microbial diversity, that gut microbiome is going to speak to your immune system and it's going to create a balance between those TH17 cells and those T regulatory cells that basically come in and regulate and change the way your body is reacting to your environment. And that to me was a huge aha because I had like every doctor thought, oh, allergies there due to these pollen and these things that are coming outside of the body. It's nothing to do with what's happening on the inside. And yet your, your insides basically dictate how severely you react to the outside world.

Yeah. So how do you clear. How do you start healing? Because it pretty much sounds, and I've seen it in my practice, I think our practice is the majority of people you can say that have an issue, you want to treat their gut, you want to make sure that their gut microbiome is amazing. That they don't have. They clean up the leaky gut as much as they can, etc. So where do you start? How do you start healing?

Always with the gut. But one thing that I have noted, and this is after over a decade of really actually more than 15 years of working with gut patients at this point, is that the diet and knowing what types of supplements to take and if you're going to use a probiotic or not a probiotic, and when to introduce fiber and fermented foods, because not everyone can eat these at, at the same time, especially if you have severe gut issues. But the other thing that I've really come to realize is that it doesn't matter how good the diet is and it doesn't matter if you're taking the perfect supplements if you're still living a very stressed out lifestyle. So all of it has to happen at the same time. And mindset. I used to talk to my patients about that in meditation and breath work and, and they would go out and they would, they would do the diet part, but they would come back and say, oh no, I didn't get to the meditation part, but I'm still kind of not feeling right. And, and they just keep focusing on the diet. I keep telling them, you know, that elephant in the room over here, you know, that that high stress lifestyle that you live is basically blocking your body's ability to heal itself. And it's not one or the other, it's, it's this and meditation, breath work, mindfulness, like changing your internal circuitry. Because if you, if your vagus nerve is not activated, if you have low vagal tone, if you're not in that parasympathetic drive, that balance between sympathetics and parasympathetics that fight or flight and that rest and relax mode, your body cannot heal itself.

So I mean, that's always the challenge. And at least in my clinical practice, that's, that's, it's easy enough to say, okay, do this diet, take these supplements.

It's a. Doing this, you know, it's really clear doing this is much easier than changing your beingness.

Yeah. Changing your mindset.

I like how you said that. Beingness.

Yeah, well, it's really, it's easy to do. It's to be, be not stressed first or be, be okay with stress.

I think people think it's, people think that it's difficult. You know, they think they, when we talk about meditation and breath work, they're probably thinking a yogi sitting in ashram, like, you know, like away from all the stress. And. And it doesn't have to be that difficult. And I start people with just. I'll tell them, just set your clock to five minutes. I'm going to teach you how to do deep diaphragmatic breathing. And you're just going to practice deep diaphragmatic breathing, which I actually have those instructions in my book for 10 minutes. I mean, or for five minutes, it doesn't matter. Because what usually happens is those five minutes go by like that when you're doing deep diaphragmatic breathing. And then what I'll do is I'll tell them, well, let's combine that. We're going to do a deep breath, deep diaphragmatic breath. And when you exhale, you're going to hum. And what that hum does, it does two things. It's going to prolong the expiration, which is really important. So that helps cool down the nervous system.

That's great.

But two longer than in, right out longer than n. Actually out longer than in.

It's a one to two ratio. So if you breathe in for four seconds, you want to breathe out for eight seconds. And that has a really calming effect. It's the two to one breath. It's very calming effect on the body and the nervous system and improves digestion, improves so many things. And so. But then that vibration as you hum on that exhale is going to activate the vagus nerve, which is coming from your brain and it's passing on both sides of your vocal cords. And it's one way that we can get into that ventral vagal tone, which is so important for healing and for the gut to function.

Nice.

That's great.

It sounds like. I feel like we're at the tip of the iceberg and that we could probably. Well, you wrote a whole book, right? So we could probably dive into this for hours and hours. So I think what we should do is probably tell people where to find you, because this is the start of the conversation. It's not the end of it. You've started to give them tips, but they think that to really get a full sense of it, they need to work with you. So how do people find you?

They can go to gutsmartprotocol.com and there they can learn about my book. They can learn more about me and what I do. I think most importantly is, you know, get the book and read it and start doing all. All the pieces of it. You know, I have a whole section that's after the diet because everybody wants to diet. Everyone Wants to be told, okay, what do I eat? What do I do? So I have the quiz. The quiz tells you if you're mild, moderate, or severe. That divides you into different meal plans. I have food lists for all different levels. So I solved the problem that a lot of people come in and ask me, like, well, what do I eat, doc? And they think, well, you've taken gluten away, so what do I eat now? Like, well, there's a ton of food out there that you can eat if not gluten. So I show people that. But then I have a whole section called turbocharging your results where I first dive into the science of the vagus nerve and why the vagus is so important in controlling the state of the internal organs. And. And then I teamed up with meditation and breath work experts to create meditations and breath work for the gut. One of the meditations I actually created myself from, from my years of that was another part of my story I didn't, I didn't share is that I had started meditating when I was 21 years old, about eight months before I went to medical school. I got into meditation, breath work, and yoga. So by the time I went into a traditional western medical school, my mind was just open and I was already experiencing these internal changes through the power of breath work and meditation and mindfulness that I had already realized the power that lies within. Beyond medication. We have our own drugs inside our body through the breath, through our, our stretch receptors in the lungs that we can regulate ourselves. And so that was a big influence on me. And I wanted to. I decided to write a meditation. I call it the gut love meditation. And it's based on my experience with the Tibetan loving kindness meditation where you send love to yourself and then to the world. Except I took that and instead I have people first start by sending love to their gut. Because another thing that I've learned and found from working with patients with gut health issues is that they often have an adversarial relationship with their gut. It's almost like they want to go through a divorce with their gut. And I want to reframe that and switch that thinking and get them to start sending love to that part of their body, because love is healing. So this part of the book is called turbocharging your results. But it's. And I, and I tell people, you know, this is going to augment your results, but it's also non negotiable. It's actually part of the plan. It's something that they need to do. And I hope that everybody who reads the book sees that and seizes the opportunity. I wanted to create a variety of options for people so they can also intuitively find what is it that speaks to you. You know, I've been meditating for more than half my life. I have not meditated the same way that entire time. I changed the meditation, I changed the style, I changed my breath work to meet me where I'm at at the moment. So I wanted to give people a variety of options and see. And I tell them, you know, see what. What is it that feels good to you right now in this Mom? That as your tool. And if. And if you get to a point where it feels like the tool isn't working, then go back and revisit and use a different tool, use a different style of breath work, use a different meditation. Because you always have to just, you know, the body's always shifting. You have to meet yourself where you're at. And part of what I want to teach people is to be really intuitive about, you know, being embodied, being in their body, connected to their body, so they can read and know what their bodies are telling them at all times.

I think that's really important. I think the thing that I've taken away from what you're talking about is the body is so dynamic, and so we do want to meet it where it is and keep changing. So we'll make sure we put that in the notes. I think on behalf of Ed and I thank you for this, because this is a great start to the conversation of how do you heal your gut? And so to the listeners, thanks for being with us. And you've been listening to Dr. Vincent Pedre. And thank you so much for being here on the podcast.

My pleasure. Thank you.

It.