Welcome to Episode 015 of the PHW Podcast. In this episode, Dr. Jeff Davis sits down with Dr. Kristen Marvin to explore the fascinating and often overlooked world of gut health. What is our gut really doing for us every day? And why does it matter so much for the rest of our health? Together, they follow the digestive process from the first bite to the finish, breaking down the role of stomach acid, the small bowel's remarkable absorption power, and the trillions of bacteria that call our gut home. Dr. Marvin and Dr. Davis walk through the gut-brain connection, explain the truth about leaky gut and its link to autoimmune conditions, and discuss how the microbiome even influences hormone balance. You'll hear real clinical stories, practical takeaways, and evidence-based guidance on how to support your gut through food, hydration, movement, sleep, and stress. If you've ever wondered what your gut is really up to, this episode is a must-listen!
Episode Transcript
Auto-generated from the episode audio — may contain minor transcription errors.
And people go, "Oh my gosh, I have no idea this is what a normal person feels like after a meal." And so they had what what they had thought was normal is just something they had experienced their whole life was that they would eat and they would have bloating and cramping and pain. They just assumed that everybody has bloating and cramping and pain after a meal. And it wasn't until they cleared out the bacteria in the small bowel and they treated that that small bowel overgrowth that they were like, "Oh, no. That actually isn't a normal thing for people to feel.
Welcome to the Prayer Health and Wellness podcast. Uh, this is podcast number 15 and my name is Dr. Jeff Davis and I have with me Dr. Kristen Marvin. Hello. This podcast, by the way, is not sponsored by Element. But Element, if you would like to sponsor the podcast, please reach out. Yes. And I'm getting over a cold, so I apologize if I cough. Um, I feel great. I just feel like my lungs are doing some housekeeping. So, getting stuff out still. Yeah. Yeah, there's a little bit of that. It's always a good thing. [clears throat] So, the topic of that we're talking about is gut health.
And it's funny because our our presentation today, our our provider meeting, we actually presented I think a really fascinating case on gut health. And there was just just reminds me there's so much going on in the gut. Yes. And I think we I still think I I think the medical field is just still scratching the surface with what the gut does. To me, it's amazing uh that we have more cells that are bacteria in our body than we have cells that are human. Yes. Which is just So, who was it that said we I think we were at like some conference and somebody said, "So, really, are we just bacteria having a human experience?"
[laughter] Exactly. I've heard anotherbody, another person explain it. They said, "We're kind of just a a meat bag walking around for our bacteria so we can transfer." But if you think I like the first one better. Well, and and also what's amazing is think about where our bacteria comes from. I mean, our when we're born born through the vaginal canal, most of us, I mean, some are C-section, but even the C-section babies now, there there are some protocols where they're taking vaginal swabs and swabbing the nar, so the nasal cavity and the in the mouth of the baby when when it's born.
Mhm. And so we're picking up that maternal bacteria from our mothers and and we really don't know what what else is being communicated with that. That those bacteria have a memory. They have a heritage. Yeah. Some of that's coming around. So I think yeah, all that to say, we could probably spend hours and hours and hours talking about the gut. So this is going to be I think more of a high level, you know, what what do we mean when we talk about gut health? What are the things we focus on? what what is our gut really doing for us most of the time?
You know, thankfully us don't have to think about our gut on a daily basis, but some people certainly do. Um, so yeah, I think uh I'm humbled. I think this is another area where you feel like the more you the more you learn, the less you know. Does that make sense? Yes, absolutely. Because like you said, seems like the medical community knows just a fraction. And on one hand, I think we do have some really cool research, right? you know several studies that have been published the microbiome project you know things like that but also you know another to look at it through another lens I think the unfortunate reality is a lot of uh conventional you know medical training doesn't even really talk about stuff like this very much a lot of medical students are just like the nope we're not talking we're not learning about the gut microbiome or you know how maybe the our gut health impacts other areas of our health too, right?
Like our immune system, our hormones, the gut brain connection. Totally. So many things. So again, like good to stay humble and acknowledge that we ultimately probably still only know a fraction of what there is to know, but also that we can use some things that we think we do understand to try to help people achieve optimal health. Right. Yeah. I'd say it's an exciting place to to learn. It's an it's an exciting part of the body to learn about because you can, you know, if you learn about something on the weekend, you can the next Monday usually apply that to your patient.
And I would say that there's very few things that I feel like you walk away, you know, from our conferences that we go to where we come back and go, "Man, I'm so excited to start applying this." Well, gut health is one of them. So, so, okay. So let's talk about when when we talk about the gut again, the anat the the the reality is people think about our mouth and our stomach being inside body. They're really not. There's there's still an exterior surface because if you think about our anatomy, we're we're really just a large tube.
You know, we have tube on the outside, tube on the inside. And so from mouth to anus, like if you swallowed a long a 25 ft string and you just kept swallowing it and swallowing, eventually that string's going to come you're you're going to it's going to come out the other end. Yeah. And that's still on the outside of your body, right? Nothing's really moved inside. Right. So the so so the the function of the mouth besides communicating um is really to prepare the food for swallowing. So we we're chewing and we're supposed to chew what is it 27 a lot more than we probably do.
I know I do. That's definitely an area I can improve on. Yeah. As a as a resident, man, we would inhale our food because you didn't you didn't have like a lunch break. Yeah. You may have had like five minutes to go grab something to eat. So yes. Yes. As physicians, I think we pick up some of the worst habits. And mothers, where my mom's at where you're trying to take care of the kids, multitask. Next thing you know, I had, you know, how many bites or basically what was my meal standing up, right? Trying to, you know, and of course, I probably chewed like three times.
Yeah. [laughter] So, when we when we start chewing, we're preparing the rest of our entic system. So, entic just means the whole system from mouth to anus, we're preparing it for that food that's coming down. So, our saliva, we're salivating. There's enzymes in our saliva that begin breaking the food down. We're we're chewing. Mastication breaks the food, increases the surface area exposure to those enzymes and then we we actually prepare the food in small little bololises and the bololis gets to a certain size and then it makes it so it's easy to swallow. Once it goes to the esophagus, the esophagus is actually designed really for just transmission to the stomach.
It's very simple, smooth. It's not the um typical mucosa that you have in your mouth and it's different from the mucosa than you have in your stomach. It's very smooth and slick. It's designed that way so things fall down. So as we come down the esophagus, we get close to uh the top of the stomach and we have a where the two leaves of our diaphragm come together create the uh sort of a a valve for lack of a better word that relaxes and opens up food drops in the stomach in the stomach you know even the process of like smelling food being cooked or talking about food um you know in other cultures they'll have a appertif before dinner that prepares the digestive enzymes so your stomach starts secretreting more acid.
Um, and again, all of that is a is a sensation to prepare. So, if we were at home cooking a meal, our stomach is probably getting ready for that food, whereas we go through a drive-thru, we've missed all the preparatory steps. Yes. Right. Because our our stomach isn't smelling the meat, cooking, and the aromomas and the preparation and all that. So, yes. So, once it makes in the stomach, it's mixed with stomach acid obviously. Mh. Uh, and there we have other enzymes that come in that are designed to break the food down further. And and this is very this is very rudimentary.
From the stomach, it passes into the small bowel. And I to me the small bowel is fascinating. And it's it's actually one of my favorite things when when I do endoscopy. Um, I will go whether I'm coming from the small bowel, from the colon side or from the stomach side, I like to go into the small bowel and I'll take a syringe of water and I'll just do a flush, right? And normally people are kind of in a dehydrated state when they come in for an endoscopy. And the mucosa just looks kind of like a pebble cobblestone road.
But when you put that water in there, uh, there's actually these villi just kind of like fingers. They're like little fingers that come up. Um, and what's cool is the wa the water as you bring the scope in and you put the scope underwater, you actually get a little magnification effect. And so you can see these and they look like little sea anemmones underneath the water. So with that water in there, it's it's amazing. You can see the villi. What you can't see is the microvilli. So the small bowel purpose of the small bowel is to absorb all that food absorb those micronutrients absorb the food the proteins the fats um the carbohydrates that we've eaten and the absorption surface for even though I can see through the naked eye through the scope the villi what I can't see is microvilli so each one of those tiny little fingers that's projecting in has more millions of little microv villi uh little tiny microscopic hairs and so When you look at the surface area of the small bow, I think I remember reading that the surface area of the small bow is is equal to two tennis courts in an adult, right?
And then what's on the other side of that small bow, that cobblestone kind of appearance, every one of those little bumps in the small bowel is a lymph node. So that is the the gut associated lymphatic tissue or you'll see it in literature is g and really 70% of our immune system. You know you hear a lot of your immune system is a small bowel. What do they mean? Well you know everybody's gotten sick and felt the lymph nodes in their their throat get swollen. You know my probably had swollen lymph nodes when I first had this illness a couple weeks ago.
Well each one of those little cobblestone bumps in the small bowel is a lymph node. And and so we have the greatest interaction with the outside world in our immune systems interaction rather is through the small bowel. And so when you look under a microscope the the there's really one cell layer separating you from the inside the inside of your body where the lymphatic tissue is to the exterior where the food is. And again, you're one one thickness of a cell away in and spread out over two tennis courts every meal you eat. So again, I had somebody tell me today that their doctor told them like, "Hey, it doesn't really matter what you eat."
And every time I hear that, I go, "How can it not matter?" Yeah. How can it not matter? Yeah. I mean, especially when you think about Americans today. I mean twothirds of are suffering from diseases that are largely caused by food [clears throat] their diet right lifestyle. So so anyway small bowel amazing amazing absorption area and and for the most part the small bowel does not have bacteria present a lot compared to the large compared to the large intestine. We would say it's relatively a sterile environment unless there is a disbiotic state which we may or may not talk about but so the bacteria that are there are probably transient because obviously we eat bacteria in our food whether we like to think about it or not sometimes purposefully we're eating bacteria in our food like the fermented foods kimchi sauerkraut um so then once we go through what 22 feet of small bowel it's a lot long um you make it into the colon and the colon I think is really for me has been um I think the place where we have the greatest mystery going on there because that's where the predom that's most of where our bacteria are trillions trillions of bacteria trillions and trillions is a huge number yes so trillions of bacteria in this in the colon and what what gets passed into the is kind of a liquidy effluent that is really nutrient depleted or should be should be yeah so we should we we should have gotten everything we're going to get out of our meals.
And what we're passing on to that bacteria are the things that we can't digest. So the fibers, fibers from fruit, fibers from vegetables, the whether they're soluble or insoluble, and those are the things that those bacteria thrive on. So in the colon, the main the main purpose of the colon besides being a home for those bacteria, I would say structurally the colon is designed to resorb water. So I kind of think of like it's the water reclamation plant for your city, right? right? Is where the water, all the waste water comes in. You clean the water and you put it back in the body.
So when we're dehydrated, for instance, your body is going to really pull a lot more water out of the stool. And so that can actually make your stool really firm, you know, dried out, little tiny rabbit pellets, sometimes that's a hydration problem. Um, sometimes when your body has something in there that that's a foreign agent, you know, let's say a bacterial infection in your colon, your body's like, we got to get this out of here. So it does the opposite. Actually says we're not going to absorb a lot of water. We're going to just let this water pass right through you and that would be diarrhea.
So that that is for me the main function is to get rid of the waste the the things that we can't use and then to absorb the water. Now along with that the bacteria produce um lots of beneficial products. In fact, one of the most important products that bacteria produce for us when we're born is vitamin K. So we're all born with a relatively low vitamin K. And vitamin K comes from the gut bacteria. They produce that vitamin and then we reabsorb that and that helps with helps us with clotting, a few other things. Um, our gut bacteria make short- chain fatty acids, but our gut bacteria also communicate with our brain, which again is wild to think about.
Yes. And and I would say there's not just bacteria there. There's there's also yeast, right? And and I think this is something I remember um it was Dr. Pearl Mutter said, and I think you were at this conference with me, and it was kind of a mic drop moment, but he said, he goes, you know, I know a lot of you guys are out there trying to to get rid of parasites. And he goes, I don't know if that's such a good idea. And then he just ended his talk and everybody was like, what what is he talking about?
But I think what he was trying to say is that, you know, for for all for all of humans existence, parasites haven't probably existed with us. Mhm. And there may be b just like we have beneficial bacteria, there may be helmets. Yeah. Right. I mean Duke University has done the study on um the um what's the name of the little bacteria or parasite that's a it's a rat tapeworm the HDC's that himanopra diminishes sister squites. So they did they did a study years ago about this and found that that actually when humans are depleted of this particular it's a non- pathogenic parasite uh that their immune systems didn't function properly and it was almost like the immune system needed that himanoptra diminishes to be there kind of like target practice so um the gut brain I think still a mystery there but again those short short chain fatty acids I mean they have shown studies where they have taken um fecal material from somebody who is an anxious person and or oh no this was done in mice first I think it was later repeated in humans but for sure in mice I don't know how you tell whether a m mouse is anxious I guess they're running around looking for cheese all the time there's there are signs usually a cat nearby or yeah they're just a little jumpy and so they would they would took the bacteria out of the mouse that was anxious put it in a bacter in a mouse that wasn't and that mouse became anxious.
And conversely, the mouse that was calm, you know, like like uh proprenate Yeah. Um is is a short chain fatty acid that's calming. And so they put the bacteria from the mouse that was calm into the mouse that was anxious and it made the anxious mouse calm. Yes. So, yes. Well, I think that's a really good summary, but I think it would be fun to kind of go back a little bit through some of those different areas and maybe just point out some other important pieces um for our listeners. So, I think I think you covered the mouth piece really well.
The chewing piece. I mean, so important, like you said, breaking down, getting that surface area increased, starting to release some of those nutrients that we know eventually, like you said, in the small intestine are going to get absorbed, right? And of course, like you mentioned too, the saliva actually does contain enzymes that get that process going as well. Yeah. AMA. Yep. Yep. And then once we, you know, get down into the stomach, I think, you know, one thing you mentioned that I wanted to come back to to emphasize for our listeners is the stomach acid component, right?
Because so often in different aspects of medicine and healthcare, acid, stomach acid is made to be a bad guy. True. Stomach acid is bad. We have so many medications on the market now. several of them over the counter, so patients don't even need doctor's guidance on maybe true risks with some of these medications. And we're told that, you know, hey, stomach acid, you know, can c and to be fair, yes, stomach acid in the wrong place can potentially cause some damage that needs to be addressed. Well, yeah. So, you're talking about a class of medications called PPIs or proton pump inhibitors.
And I think, you know, I I love Thomas Soul. I I love this guy's an economist and he's just so wise, but he has a saying that he says there in in life there are no solutions, only trade-offs. And I think PPIs for a lot of doctors seem like a solution, but there are trade-offs. Big ones. time. So, you know, the solution, one thing that's amazing about PPIs is you rarely have people dying from bleeding ulcers in the gut, you know, I mean that that was a a gastric ulcer would cause someone to bleed out rapidly.
I mean, that was not uncommon. And I think that is fairly uncommon now because of PPIs. So, in a way, you could say that those were amazing life-saving. But you do have to remember that acid has a very important function. Yes. Uh and not just in breaking down the food, but it's also to kill things. Protection. Yeah. So, as we use PPIs, we see more uh you know, we see um maybe we're not absorbing our minerals as as much. We're not breaking down the food properly. But more importantly, we're not killing the pathogens that get passed on.
I've absolutely [clears throat] seen this in the clinic and we do have I think data to support this that long-term use of PPI or proton pump inhibitor medications that essentially are reducing the amount of stomach acid that you said then can lead to some of these like nutrient deficiencies can be correlated with things like low bone density. Um I have absolutely treated patients in the clinic that very quickly after starting these medications um came down with intestinal infections. Cadiff again, you know, maybe made them more susceptible to like some of the microbes associated with food poisoning, but you know, I don't think that's probably listed anywhere or maybe it is in very tiny small print on some of these medications.
So, I don't think patients are, you know, truly being informed. Well, actually, when you look at something like omerazol, which is a generic um PPI, it says on there, don't take for more than two weeks. We have people taking them for two decades. Yes. Yes. What I think what's fascinating too is that again we always think of like okay well if you have heartburn you must have too much stomach acid. Therefore let's suppress the stomach acid and we'll fix the problem. And and I think there are a fair amount of people who have heartburn from actually a um I would say a dysfunctional stomach acid.
You know as we age we don't secrete as much stomach acid. Our stomach acid isn't as isn't the pH isn't as low as it used to be when we were younger. So if if you have something that is supposed to dissolve food, break it down, the stronger the pH, so lower the pH, the faster it can do that. If you have a weaker pH, your body has to secrete more gastric juice to do the job because it's got to get the job done. So I think there's a fair amount of people that have heartburn that are actually secretreting a higher volume of weak acid.
Yes. Yes. So, so they're secretreting their acid for a longer period of time and and the more volume they have, it's just splashing up into the esophagus and that's what it's causing their heartburn. And in those patients, you can you can actually it sounds very counterintuitive, but you can actually give them extra acid with meals in the form of you could use apple cider vinegar, which is an acetic acid. It's a little weak, but it works. You could use betane hydrochloride, which is a much stronger acid. It's available as a supplement over the counter. And so we will have people who will take extra acid and their heartburn goes away.
And you think, how is that possible? Heartburn's supposed to be from too much acid. So again, I guess think it's one of these things the more you learn, you realize it's just not as simple. Well, and nobody's asking why, right? Like we should go back to even like you know the cases of these people who end up with bleeding ulcers. Why? Why do they have a bleeding ulcer? Yeah. you know, well, in a lot of cases, they were on ibuprofen or they were taking aspirin for, you know, and then that's all that's decreasing their protective lining of the stomach.
So, yep. The way sometimes I'll describe it to patients in the clinic is that, you know, your stomach was designed to be an acidic environment, right? In fact, I think from compared to most mammals, I think we have one of the most acidic stomachs. A lot of times what happens you know obviously like gastritis inflammation of the lining of the stomach is a very real thing and can cause very uncomfortable and even painful symptoms for people. this can be a cause of you know stomach pain, digestive issues and um what I try to help them understand is like we need to find the thing and oftentimes that's plural not singular right so the things that are driving the inflammation in the stomach so that the barrier improves and then that stomach acid that's there doesn't hurt anymore because sometimes rightfully so people are like yeah but I tried that over the counter omerazol and I felt a lot better so I'm like think of it this way Because many of us have probably had a situation like this where you know or us ladies who shave our legs you know especially if you happen to be traveling and you're in the ocean the ocean water is very salty right and so if you have a cut on your leg or even sometimes just shaving you go right into the ocean and that salt water so again the skin barrier is compromised you feel it it stings so similarly I think we can think about that stomach lining in a similar way where it's like we got to find the things or whatever it is that's causing the inflammation that's that's essentially compromising the tissue integrity.
Yeah. And then that stomach acid is not going to hurt you anymore in in how they have, you know, the symptoms of gastritis or that type of thing. Yeah. So, well, and chronic stress can make you 100%. have that that can be a reduction in your barrier. And so, how many people chronically stressed? That's a big problem. Huge. Huge. Okay. So, that's kind of stomach. Let's go back to the small intestine because I agree with you. Small intestine is fascinating. There's a lot of stuff happening there. Yeah, I know we're focusing mostly on the gut, but I think we'd be remiss if we don't say as part of the digestive process, we are getting uh enzymes from the pancreas that are entering the top of the small intestine and also getting bile.
Y that is essentially made in the liver, stored in the gallbladder for those of us that still have a gallbladder. If you don't have a gallbladder, essentially what happens is you still have a tube, a connection from the liver to the small intestine that essentially is just trickling in bile, right? Instead of having a controlled organ that's squeezing it in in the presence of food. Yeah. You no longer have the ondemand system, you know, because there's hormones in the stomach that communicate. Yes. Close colistinan is a hormone that says to the to the gallbladder, squeeze.
Gallbladder is a little muscular bag. And so yeah, that when that bile comes in, that bile salts purpose is really to break down fat. Yeah. Into really tiny little particles called myals. And then those actually get taken up under a different absorption system called the lactal system if I remembering correctly. But yeah, bile is really important. And so bio that's another supplement that sometimes you know like the case we presented today where we had a patient who we did a fecal analysis and found out that they had a high statocrit. So statocrit is a way of measuring how much fat is left over in the stool after it passes through.
It should really be ideally I think under 18% that patients was close to 60 if I remember most 40 40%. So clearly they were not breaking down fat and absorbing it. they were not and therefore they're not absorbing and that means you're not you're not you're also probably deficient in fats soluble vitamins right so how many people are walking around with vitamin D deficiency vitamin A deficiency you know all of the fats soluble vitamins so if you know if you don't aren't breaking those those down then bile acid taken as a supplement you'll often see it as ox bile which really is just it's just bile from a a cow's stomach or cow's gallbladder um that can be taken as a supplement so that you are able to break down your fat.
Yep. And then digestive enzymes to bring that up. That's another one that some people have, you know, p the pancreas has two functions, endocrine and exocrine. Endocrine meaning it's making something that's being distributed throughout the whole body. So that's insulin. Um one insulin is one of the things and then exocrine would be the things that it excretes into the gut. And so that's our uh enzymes that are further breaking down the food. But as we age again some people have a lower function in their pancreas. We call that pancre pancreatic exocrine insufficiency and that again there are supplements.
There are drugs also that can help with breaking down those like um their pancreatic enzymes supplements. Yeah. Even they're regulated as a medication but it's technically an enzyme. It's an enzyme. Yeah. Yeah. Yeah. Um and so again, these are all things that when when we have someone coming in and they're having gut problems, you know, they say got to think about you got to think about every step. Yeah. The small the lining of the small intestine also produces different types of enzymes that help us break down different types of, you know, carbohydrate structures and things like that.
And then of course our microbiome. The microbiome, you know, like you were mentioning about fiber and things, it definitely plays a role in digestion and is important for digestion. And we know that when these pro these, you know, normal processes that we're describing aren't working as well, absolutely can lead to disbiosis or an imbalance of our microbiome. So, it's pretty pretty a fascinating at least just what we know. There's probably still a lot we don't know about some of these processes, too. There's so much so much. Yeah. So much. Well, and I, you know, the other thing I think is fascinating is to think about that most of the volume of the stool that you're passing is actually dead bacteria.
That's a lot of bacteria. Um, so weird, you know. So, let's talk a little bit about a healthy bowel pattern because I think a lot, you know, people don't people don't talk about their poop enough, but you have a book in your room. I have a poster in my room. You have a poster in your room. Big poster. It's a Bristol stool chart. So, it's technically a medical tool. Yeah. It's not like I have weird pictures of poop on my But it's a scale one through seven. Yes. Starting with like what looks like little rabbit pellets going all the way down to what's just watery diarrhea.
Mhm. And I feel bad for Bristol in the UK because it's probably a lovely town. [laughter] All they're known for is this poop chart. Are they though? Or is that just us? Maybe. So I don't know anything else [gasps] the town of Bristol other than this poop chart. Yeah. Um, and then I would say the other thing that is is important is understanding what's normal. And I'll tell this is kind of a funny story, but I had um had a mother and her daughter uh come in and they they actually drugg their 16-year-old son/brother into the appointment.
And you know, this poor kid, he's sitting in the in the exam chair and the um mother and the daughter are over sitting on the couch kind of how my my exam rooms were set up. And I said, "Well, what what are we here for today?" And they go, they pointed at him, they go, "He has got a problem. He's going to the bathroom all the time." And so I was like, "Okay, okay." Right. Um, so are you having any pain? No. Any blood in your stool? No. Is it watery? No. Are you having diarrhea?
No. Like, so how often are you having a bowel movement? And he goes, "Um, I have probably three times a day." And I was like, "Oh." And the mom and the daughter are going, "See, he's pooping all the time." [laughter] And so I I looked over them and I go, "Well, how often are you having a bowel movement?" And she said, she goes, "Like a normal person, once every 5 days." Oh gosh. And the daughter's shaking her head like that. And I I looked at the the kid and smiled and I go, "You guys need to switch places."
So why was he normal? Well, the one of the things that happens when food enters your stomach is you get a gastrocolic reflex. And we were talking about this in our meeting today. There's a there's a reflex meaning that the brain is not involved. So, it's monosinaptic one synapse. So, there's a nerve that goes from the stomach to the spinal cord, spinal cord to the colon, and essentially says to the colon, make way. There's there's a meal coming, so you better you better start kicking whatever's there. Kick it out. And so, the colon starts squeezing and and that the the the muscle the muscular system of the colon is also amazing.
We haven't talked about that, but that the fact that things reliably move in one direction is really cool. And thank [laughter] God. Thank goodness, right? cuz it would went the otherward direction, you'd have some problems. Have some problems. So, what he's experiencing is is three times a day he's having a meal and about 30 minutes after the meal, you should have a an urge for a bowel movement. Now, you know, as humans, we can control that part. And, you know, after we get past our toddler years, we're potty trained. And that's essentially your brain squeezes, it goes into the rectum.
The rectum says, "Hey, I'm full. Better find a toilet somewhere." Um, and if you if you ignore that, then you know your colon stops telling you and you have to wait for the next meal. So, I think my theory is these these two women had and and this is actually something I see more commonly with females. Um, they had just learned to ignore their gastrocolic reflex. So, they were not feeling the urge to defecate. Um, and and I joke and I said that I think that's because women are homefield advantage poopers, right? They most women just only want to poop at home.
Oh, and I remember as a resident on the OB floor, the nurses, they had a system for when when one of them needed to go to the bathroom there. It was like a hidden signal that no one else could go and there was some bathroom on some deserted wing of a hospital that nobody knows about bathroom and that was they were like everybody knew like okay if they're going nobody can go. We got to wait till they come back and then we'll send in another one. So home field advantage you know they don't they don't want to poop at school.
They don't want to poop at another person. Whereas men, you know, we think about I mean, first thing we get to work, we're like going to go poop. We get paid to poop. Yeah. So, I I don't think guys have as much of a problem. They don't think about it like that. But that was really funny. That kid had the biggest grin on his face. Oh, he was so thrilled. I bet. he was so happy to know that he was the normal one. And and the and the mom when I told her that she really should be having a bowel movement at least every day.
Yeah. I [clears throat] mean, we've gone to uh some of these, you know, uh dinners of sorts where there some specialist is talking about different types of medications, and I feel like we went to one where they were, it was a they were talking about a drug that we used that was used to treat constipation. And I remember listening to the gastronurologist talk about how um you know, hey, this drug it it had great great results in the trials. It took, you know, people who were having, you know, like one bowel movement a week up to like three bowel movements a week.
And I'm just sitting there like scratching my head a little bit going and and he's talking about how it was just so great in his clinical practice. And I'm like, "Okay, buddy. Either I don't know what kind of patients you're seeing that are happy with that." And two, maybe you're just not listening to them. I don't know. So, I did I raised my hand and I'm like, "But don't you think like shouldn't people be having at least one bowel movement a day?" And this guy seriously was like, "No." Yeah. No. Yeah. In gastronurology actually the the area under the cur, you know, if you look at the normal distribution of the curve, Yeah.
it's a bow movement. It's it, you know, anywhere from uh three per day or once every three days is considered normal. Oh my. But again, that's that's a giant area under the curve. And so I always like to go back to physiology and go the gastrocolic reflex is there for a reason. Yes. Right. Yes. And so, so for us, we, you know, we often talk about what's normal on a lab and what's optimal. So, okay, a bowel movement once every 3 days is technically normal by the American Gastronological Society's rules or whatever. Yeah. But what's optimal is three times a day.
And at the minimum when we say at least you should be taking the trash out once a day. Once a day. And again, I mean, myself included, TMI for a lot of our listeners, but I know a lot of our listeners also feel terrible. they're coming in complaining if they're they're uncomfortable if they don't have at least one bowel movement a day. Well, yeah. I mean, you it it actually can be dangerous. I mean, if you're not having a bowel movement, there is a point where you become toxic. And um because again, remember the colon's job is to reabsorb water.
Well, there there's a point where you you Yeah. What else is getting reabsorbed? What else is getting reabsorbed? So, having that healthy movement through there Yes. Um is super important. Yeah. Okay. Okay. So, we're in the small bowel still. Yeah, we're in the small bowel, but I don't know. I mean, you've mentioned like you even just said kind of once we get to the colon, we're not really in like a digestion phase at that point, right? And I skipped over the ilioal valve, which I think is important. Yeah. Go ahead. So, ilioal valve is um is again another valve kind of like the the two leaves of the hemiaphragm coming together at the top of the esophagus, the cardia of the stomach.
Um, you also have a valve before the liquid that comes from the small bowel is introduced into the seeum, which is the first part of the colon. And that valve is actually lymphatic tissue. And and it kind of when you look at it on a in an endoscope, it kind of looks like a fish mouth. It has like a it's kind of a fish mouth that's closed most of the time, but it does as you sit there and if you take time and watch, it'll open up and kind of like a fish mouth. Kind of like a fish mouth.
Yeah. Um, and and you can actually have so just like you can have reflux of acid back into the esophagus, you can actually have reflux of that liquid fecal material back into and again that's that's an area that's rich in bacteria. And that's also where your appendix is, by the way, that little flappy dangly thing that nobody needs anymore. Yeah. Turns out matter. that's an important structure. Um, yeah. That is probably the seed of our it's it's sort of like our original library of the blueprint of your microbiome. It's a blueprint of your microbiome. If you wiped out your whole microbiome, you theoretically could rebuild it from whatever's in that little appendix assuming you still have your appendix.
So I think function of the illeal valve is something we don't talk about a lot. But now there's people who are really getting into understanding well what is the function of the ilioal valve? Can we prove the function of the ilioal valve? So I think there's just a lot we don't know about it. Right. But yeah, so then that brings us into the colon. What else did we want to say about the colon? Did I do we cover? Well, I think there's definitely some things we go back to. Um, but let's touch base for our listeners, too.
We've talked a lot about the function, but let's talk about like what this means for them clinically, like what are they experiencing or what could they be in their day-to-day life? The actual symptoms of like what's considered. So, we've kind of talked about like, okay, this is what a normal bowel movement pattern looks like, but when we're talking about, you know, because so often so many people experience symptoms that are just like even doctors do this, they'll be like, "Oh, that's normal." Yeah, it's not normal. It's common. There's a difference. So, that's a great point.
Let's go go through some of the things that like, hey, so before we talk about dysfunction though, we probably should talk about what nor what a normal person should feel like after a meal. And this was a a powerful lesson. So I had the privilege of being in the the Zyaxin clinical trial um as a as a principal investigator for that. Um that so that's the antibiotic that you were referencing before that we used for to treat SIBO. And in that trial the specific trial we ran was the retreatment trial. So people who had failed the first treatment came in for second.
So in that trial it was amazing because we would have to collect from people like what are your symptoms before and and often times they would say you know they might not report any symptoms but there were quite a few people that when they came back after being treated with Zyaxin and that had cleared up a problem for them they made they made this comment and I remember this comment saying said over and over again people go oh my gosh I have no idea this is what a normal person feels like after a meal. And so they had what what they had thought was normal is just something they had experienced their whole life was that they would eat and they would have bloating and cramping and pain.
They just assumed that everybody has bloating and cramping and pain after a meal. And it wasn't until they cleared out the bacteria in the small bowel and they treated that that small bowel overgrowth that they were like, "Oh no, that actually isn't a normal thing for people to feel." So again, I think the normal thing is we get hungry, we make our food, we sit down, we chew slowly, we enjoy. I mean, in other countries, I don't know if you ever you've traveled to other countries. Mhm. When you sit down in Italy for dinner, you're sitting down.
You ain't going anywhere for a while. Yeah. And and that waiter knows that's that's that they're like, I'll be back in an hour. That table's going to be here all night long. Yeah. Uh, so they they just know, they slow down, they talk, they're the meal is a is a is an event to experience. It's not something to get through quickly. So, I think that's something us Americans could probably learn. Yeah. But, so we're sitting down, we're chewing, we're taking time, we're resting and digesting after the meal. So, people often will just socialize, maybe go for a a light walk, um, kind of allow that food to break down.
And again, you should not have diarrhea right after your meal. You should not have bloating, cramping, pain. Yeah. After a meal, you shouldn't have difficulty with swallowing. You shouldn't feel like you're choking. You shouldn't feel like stuff gets stuck. Yeah. You shouldn't have pain with swallowing. You shouldn't have burning or, you know, a warming sensation or anything like that, like especially in the upper part, right? Closer to like your chest or your throat, right? And then 30 minutes after the meal, you should probably feel the need to go to the bathroom. And so, so for some of our patients who have forgotten what the reflex feels like, we'll tell them to go perch.
You know, get on a bowel program. Yeah. Bowel training. So, you go 30 minutes after meal, you set an alarm and then you just go sit on the toilet. Not not for a long time. It's just more to kind of train your body that, hey, remember what this is for. Yeah. Um, but yeah, I think that's that's normal function. Yeah. And gas. I mean, let's talk about gas a little bit because I think there's a balance, right? There's probably a sweet spot when it comes to gas because our a very healthy normal microbiome will produce gas.
Yeah. Right. Two liters of gas a day. Sounds like a lot. [laughter] Some people are gassier than others, but but probably it's not we wouldn't consider it normal if somebody's like, "Wow, I am belching all the time or I belch a lot after I eat or drink." Right. Um, you know, again, like you mentioned, not normal to feel super full or bloated. Um, or sometimes people, yeah, they'll describe it more of like a fullness or that they just, you know, a lot of women, you know, that have especially been pregnant, they're like, I feel like I'm like 6 months pregnant.
It's always 6 months, too, by the way, which is I think is kind of interesting. But things like that are not normal. Feeling full if you've eaten too much. Okay. Well, that's arguably, you know, an expected response. Well, and one thing we glossed over is, you know, again, we call it the small bowel, the large bowel. I mean, the small bowel is much smaller in diameter. And so, and and it's longer than the colon. And so, when you have bacteria present there that aren't supposed to be there, maybe they've set up a colony in the small bout, then those the food that you're eating that you're supposed to be absorbing and digesting now, the bacteria are getting access to it and they ferment it.
That fermentation produces that gas. I if anybody's ever made kombucha at home, you know, you always got to have that little thing to kind of got to burp it, burp out the extra gas. So, when I hear someone who says they have a lot of burping um after soon after eating a meal, that to me says probably they have an excess gas production in the upper small bowel. Um when they say they just produce a lot of gas um from the other end, flatulence. Flatulence, right? We've got aation and flatulence. What did you call it today in our meeting?
What did I call it? An air biscuit. Yeah, we were talking about sulfur air biscuit. Floating an air biscuit. I don't know. That's something we said as kids. Sorry, I just had to. That's so funny. So, so there they're really two predominant sources of of gas in the human body. And one is swallowing. I think swallowing is one that's not often recognized. Yeah. Because we do swallow a little bit of air with every gulp. So, so some amount of gas, some a little burp here and there is not I don't want people to run to their doctor and go, "Oh my gosh, burping after a meal."
And I heard Dr. Marvin say that you're not supposed to burp after me. I to clarify, if you rewind, I said it's not normal to burp a lot. A lot, right? And and what is is it Japanese culture where it's a it's actually a sign of respect to burp with a meal? Or maybe it's Japanese. There is a culture where if you let out a big belt that's like, "Hey, I like the meal." Uh so swallowing air. So if people have post-nasal drainage and they're constantly swallowing, they can actually have a lot of gas production.
Mhm. Oh, okay. Pause for a minute because when you say that, that's another symptom sometime that people don't realize it's digestive in nature. It feels like they constantly have to clear their throat. Tell me more. So that can actually be a sign of reflux. Ah, irritation back up. Now, some, you know, we live in one of the top allergy centers, you know, or centers cities in the United States. So, sometimes I do have to try to figure out with people, okay, is this coming from up top or is this coming from because, you know, people, especially a lot of people again in this area, they're like, yeah, I'm on all the Claritin, all the Algra, all the nasal sprays already and they still have symptoms.
So pay that is something to pay attention to especially after eating especially after drinking certain things especially things like coffee, alcohol, soda, you know. Well yeah and alcohol so one of one of the things alcohol does again to that little sphincter at the top of the stomach. Alcohol relaxes that. Nicotine relaxes that sphincter. Peppermint and spearmint relax that sphincter. Yeah. um you know, eating a heavy meal and then going and laying down can make that heartburn worse. So, I've always said if you want to have the worst heartburn ever, go eat, you know, pizza, smoke a cigarette, uh drink uh a glass of wine, and pop a dinner mint and go lay down.
Go lay down. You'll have terrible heartburn. I don't recommend anybody do that, but yeah, just an example of all the things that you could do wrong. So, yeah. So, so just like that burping, the excess production, I think a lot of people who have SIBO, their presenting symptom is heartburn. Mhm. Sometimes, right? Because you're bubbling all that gas up through the gastric acids. Yeah. Well, and that's a good that's a good point to also draw attention to that just because you don't maybe have some of these more classic textbook types of symptoms, right? When we're talking about some of these what are arguably abnormal or not normal symptoms, doesn't always mean that the gut is still in good shape.
Sometimes there are some weird or just what we feel like are weird or just not the most common symptom presentation or where the patient will actually present with a specific type of condition where we have come to understand that there's a very close connection to the gut. Right. So like you mentioned earlier with the immune system, right? The majority of our immune system being in the gut. This is why any patient with an autoimmune condition that walks in our door, we are asking about the gut. We're looking at the gut, doing like you mentioned, you know, fecal microbiome testing or breath testing, those types of things, because sometimes, yeah, it's things like Hashimoto's where we know that there's potential correlation with things like um H pylori overgrowth or even yeast overgrowth or strep, you know, which is a type of bacteria overgrowth.
Again, we're not saying that's the only thing that triggered that condition for that patient, but we do find in the literature these strong correlations with these conditions and people that have certain types of autoimmune condition. Well, and I and I would say I would say it goes even further than saying it's a strong correlation. I think that mechanistically there is a path that makes a really a lot of sense when it comes to the gut. So again, we we talk about that two um tennis court surface area, half the width of human hair away from 70% of your immune system.
So let's talk a little bit about when when we talk about leaky gut which a lot of our doctor colleagues they roll their eyes like oh my gosh leaky gut that's maybe less so now definitely like 10 plus years ago when we would be going to some of these you know either talks or conferences where nobody believed in leaky gut everybody was kind of like what yeah you doesn't leak leak and so I think for me you know listening to a guy like Allesio Fisano who who is um amazing researcher at Harvard uh discussing in his lab what he's learning about tight junctions at the cellular level uh about he's the one that his lab discovered zulin which is a protein that gets exposed when you know you you think about those those microvilli those cells um if the microvilli my fingers and my palms are tight together the tight junction is supposed to seal so that everything has to be absorbed through here well what happens with leaky gut is we get a compromised barrier and now those proteins means instead of being absorbed into the microi being processed by the cell and then presented to the sorosal surface of the cell you know mucosal sorosal they are passing through in in large part probably unchained unchanged so now those food particles are now having access to the immune system they're in an immune privileged space where they shouldn't be well your immune system's function is to decide what is you and what is not you when an amino acid a fatty acid a vitamin and a mineral comes in, your immune system isn't reacting to those.
Our our immune system never reacts to those basic u building blocks of life. But if an egg protein comes across, your immune system is going to look at that and go, that's not supposed to be here. So what does it do? It makes an immune response. So we get an imunoglobulin that's formed. That imunoglobulin then attacks, you know, neutralizes the egg. Again, uh in some cases this might be an allergic reaction, but in a lot of times it's just immune dysregulation. It's not Well, it goes back hyperimmune where you're getting like your throat swelling or your lips swelling or your tongue swelling, your hives are itching.
Sometimes you do sometimes you do, but it goes back to your point earlier when you were um highlighting the cell layer, the single cell layer barrier, which seems, you know, in some ways it's like, oh gosh, I mean that does really arguably leave the system very vulnerable. But then when you throw in that the majority of the immune system is there kind of like you just referenced. It's like the army. Yeah. That's there to protect you. The guards are a lot of sense. It makes a lot of sense. It's like [clears throat] if we if we had um a border between us and a dangerous country, where would most of our military be?
Right at the border. Right. They're like, "Well, these are the guys that are trying to kill us, right? So, we're going to station ourselves right on the other side of this wall." Right. And so so that leakiness isn't really a leaking like a civ. It is a molecular uh excess permeability. Yeah. And so I think when when you talk about when you look in the literature, the literature just describes as abnormal gut permeability. And that that in essence is what people are calling leaky gut. So So that is a pro tip. If you're ever talking with somebody, especially a medical professional, use the term intestinal permeability.
Intestinal. It's a lot less triggering. Yeah. But that so so again mechanistically what's going on so you're having these proteins that are non-harmful for the most part leaking into a priv privileged immune space you're getting imunogloabbulins being produced and the problem is the more imoglobulins you're producing you can get into a condition called molecular mimicry right so if you make an imunoglobulin and and think of a kind of a lock and key structure you create a key that can un unlock a certain lock but that sometimes that key might work in multiple locks and so sometimes that imogloabbulin that is attacking the albammen of the egg that's coming across could potentially also attack your thyroid, right?
And and this is why we see for wheat, right? A lot of people have Yeah, there is evidence for that and glut gluten the protein gluten. So the protein gluten and wheat that there is there is absolute evidence of cross reactivity of that gluten imogloabbulin with your thyroid gland. And so again, why is it so important that we put people on thyroid placement that's gluten-free? because a lot of our thyroid patients react to gluten right so that that mechanistically I mean again it's not just a correlation there is a very um from a basic science understanding we understand that that molecular mimicry can create cross talk where now your immune system is attacking you and that's autoimmune disease right it's a misrecognition of your own self as an an invader y and so I think the stronger our gut barriers or less permeable it is the less likelihood we have of creating those potential immune reactions that we don't want.
What are some common conditions that you see coming to the clinic where you're like, "Oh, this definitely is connected to the gut." Well, like you said, with immune any autoimmune disease, we immediately I mean, we're going to we're going to look at a lot of things, but the gut was going to be probably the primary thing that we focus on. Skin, eczema, psoriasis, allergies, asthma, eczema. Yeah. Your skin is a mirror of what's going on in your body. Joints, joint pain. Yeah. headaches. Yeah. Yeah, for sure. One one thing you referenced earlier, we should probably circle back to kind of in this vein of just the connection with the gut and how it's connected to all these other areas is I really I want to go back and talk a little bit more about the nervous system component with the gut because the gut is so heavily innervated.
I talk to my patients about this all the time. Um because sometimes people will look at me and be like, "I know this sounds crazy, but I've really discovered this correlation with like this kind of like emotional stressor or or some patients even are just like I just am trying to leave the house for the day and my gut is like going crazy like what's going on and there you know of course and and rightfully so everybody should be questioning things like was it something I ate? Was it a supplement I took? was it, you know, this, that, or the other.
But sometimes people when it comes down to it, they're like, I was fasting. I didn't take anything. I was going to my fasting lab appointment. You know, all these different things that they've tried to figure out like what is triggering my gut. And uh and so many times we were able to tie it back to the nervous system. And I think again when we kind of start to talk about how it's like the gut being heavily innervated, the gut even having its separate intervation from the brain. So if that line of connection you know through like via the vagus nerve for example coming from the bra bra bra bra bra bra bra bra bra bra bra bra bra bra brain stem going to intervate the gut was severed the gut is still inervated by the entic nervous system that's like a gazillion I mean it's not a gazillion but it's many many many neurons in these nerve cells that essentially keep it doing things.
Well, you know, the ancient Greeks thought that the seat of human emotion was in the gut, meaning the brain, the brain. And I remember, you know, I had a I had a German anatomist in in med school, and he used to say, "Z gut is the second brain." And I never really understood what he was talking about, Zut. And you know, some of the same neurotransmitters in the brain we find in the gut. And that doesn't mean that the gut is producing serotonin that goes to the brain, but ser the serotonin similar function. There's a lot of serotonin made in the gut.
Yeah, it's important to remember there's peripheral response, right? Like neurotransmitters are not just inside the brain, right? But and so when people feel anxious, you know, they have a bowel movement, right? And and you and I graze animals. What do you see with your animals get startled? Oh, they poop. It's like every time I try to get my cow into the stansion, she starts pooping. I'm like, "Okay, really? I'm just trying to milk you. I'm not being nice. I'm giving you a treat, you know." Oh, yeah. Animals trying to load them in a trailer. But yeah, where do you think all these phrases came from?
Go with your gut. what's your gut tell you? What's your gut feeling? Right? You know, it's a very real thing. So, I think it's a very valid and and you know, again, humbly saying like to the extent that we can as human beings understand it. Makes a lot of sense. I give a lot of validation to my patients who are just like, I know it's like people just keep telling me it's in my head and I'm like, no, it actually is in your gut. Well, yeah. No, I I had a patient today that was on the phone with her and we she's going through a tough spot.
She's got um you know a breast biopsy that she's waiting to do and she doesn't know what the outcomes are going to be. And of course she's just you know her husband had a a lung biopsy so a little bit of a lung cancer scare and you know and so she's just in tears and then she says and I'm and I'm just I have this diarrhea several times a day you know and I went through and made sure I'm like okay well there's no blood in your diarrhea is it got questions have you taken an antibiotic recently?
No no I haven't done any of that. I'm think this is stress right? So this is like a stress response. So yeah, but helping I think it's really helpful when I explain that to patients because otherwise even sometimes when I tell them it's a stress response, they're kind of like, "Oh, you're like everybody else just thinking I'm crazy or in my head." So I really make a point that they understand and that I'm validating that and that a lot of times that's a missing component. It's like we optimize digestion, we optimize their diet, we, you know, sometimes use probiotics and all these things that a lot of people in today's world know are good for the gut and they still have symptoms.
That last remaining piece can sometimes be I need to regulate my nervous system and then those bowel movements and digestive symptoms fall into place. So just so our listeners understand um and like some of the things you know sometimes it's like if patients oh and this this would be a perfect another ca you know case example of somebody coming in where we're going to look about in the gut anxiety, depression, brain fog, mood swings, right? All those different types of things. Absolutely we should be asking you know you know us we're asking about the whole picture but absolutely should be thinking about the gut.
Yeah. Okay. Okay, so we've talked about gut function. We've talked about things that can go wrong, symptoms that things aren't properly balanced. What are some things that people are doing in their daily life that may be making things worse in their gut that they might not know? Some common things that we do bad habits, for instance. What are some ways we can disrupt our gut function? Poor sleep. sleep is a big one. Yeah. Poor sleep. not getting enough good quality sleep because ultimately that's certainly a physical stressor on the system. Yeah, that's probably even part of the mechanism is how like our immune function declines, right?
If we're not sleeping enough. Um, alcohol. Oh, yeah. I was going that actually I was going to say beverages like when we talk about nutrition with people, people really hyperfocus on food and they don't think about liquids that they're drinking. So, you know, obviously, and these cans, by the way, this is just salt water. Yeah. Flavored salt water. We're not drinking soda. Although, hey, shout out to some really cool, you know, I'm I'm so thrilled because, you know, it's like years and years ago, even when I was a kid, I mean, we didn't have a lot of these really cool product alternatives, you know?
No. I mean, like, and of course, I'm referencing since we mentioned soda, like Poppy and Ollie Pop. Yeah. You had Coke, Pepsi, Dr. Pepper, Mountain Dew. I mean, I'm looking at this like O lollipop label the other day. I think it was the one you had. It was like 9 g of fiber. Yeah. Most Americans don't even get 9 g of fiber in their food that they eat every day. Not not saying that they should drink a bunch of poppies for their This is definitely not a, you know, a plug to be like, "Oh yeah, just drink, you know, drink four four Ollie pops a day to get your 35 choosing between a Coke and a poppy."
Oh, it's like so obvious. It's a better huge difference in calories and everything. Yeah. like you said, alcohol. Um, I know everybody loves their caffeine, but I do think sometimes coffee, and I'm not even saying caffeine is necessarily the problem. I think there's other things in coffee sometimes that can cause inflammation, micotoxins, chemicals. I know cuz you're a caffeine addict. So, I'll push back only in this that I would say yes, I agree with you. I think coffee can be a problem, but I don't think it's the coffee that's a problem. I think it's the it's because it's one of the most heavily sprayed crops.
Well, right. That's why I said agriculturally getting a lot Yeah. You're getting a lot of chemical cuz most people, you know, drink organic. Everybody's, you know, lining out the door at Starbucks, which is like I mean, so toxic. I mean, if you read my newsletter last month, Yeah. I mean, you're getting you're getting non-organic coffee. Yeah. It's going into a cup that's not paper. It's plastic. That's why it's plastic lined. See, the addict couldn't even hear my my preface to that. I gave it a preface. I'm teasing a little bit anyways. Yeah. Um, but no, I hear you.
Yeah. So, liquids eating energy drinks. How about How about probiotics? Right. Probiotics are good. Shouldn't everybody be taking massive amounts of probiotics every day? That's such a good question. Don't we give everybody that comes in a clinic a probiotic? Absolutely not. I don't take probiotics. I don't either. Anytime I've tried um my gut was like, why? What? What? What? What? What's this? What's happening? Well, if you think about it, you're putting a big load of bacteria Yeah. into Yeah. It has to go through that 22 feet of small bell and hopefully it doesn't stop and get set up as a colony there.
Yeah. So, if we're going to do probiotics, we probably should do them as rectal probiotics. That's interesting though because I think my understanding is of most of the literature on probiotics is that they they're not really colonizing. Most of them are not colonizing. They're probably support for healthy bacteria. I I love I can't remember where I heard this so I'm definitely not going to take you know I don't want to take credit for it but um just that we can think of probiotics as like travelers passing through. So, it's like if you know when you and I go on vacation, wherever we go, it's like we're paying for a hotel, we're going out to eat, we're stimulating the economy, and then we leave.
I know where you heard that analogy. Oh, where? Tell me cuz I've obviously forgot where it was me. Oh, of course. Yes. Please take credit for No, it really Yeah, it truly could have been. But the tourists are supporting the local economy. They don't live there. They're there transiently, but they are definitely good for the economy. And to go back to like what you've been saying, you know, I love analogies. Yes, you do. I just I feel blessed that you remembered my analogy. Well, I'm glad you remembered. So, um, but even how you said like how people are, you know, using uh like the HDC's, like the beneficial, you know, just these, they're just traveling through giving us some type of an immune response that sometimes really helps people if they have certain types of autoimmune conditions or inflammatory conditions.
But yeah, no, we don't give probiotics to everybody. We want to be very intentional about them because we do use them therapeutically. So there are times when probiotics are very beneficial. Absolutely. But but I think I think my my word of caution would be to people a probiotic isn't necessarily beneficial for everybody. Yeah. And so if you feel worse when you take a probiotic that's a sign you probably shouldn't be taking one and it's seems self geneneralally. Yeah. Generally that's good advice. So then there's antibiotics. So we're going to talk about probiotics. We got to talk about antibiotics.
True. Fortunately we don't use very many of those in the United States. Yeah. Hardly any at all. Right. So, it's really not a big issue. Yeah. I wish I think what's the is it still true that one course of of an antibiotic can disrupt your gut flora for up to a year? Is that right? It's difficult and I feel like, you know, this is something we I feel like we run across anytime we're looking into the literature. I feel like I can find studies kind of arguing both sides. So, I think yeah, it's fair to say that we do have maybe some literature that suggests that it really can cause some major disruptions and we've absolutely seen that clinically.
Sure. Right. I think it's you're more likely to see that in individuals that are on antibiotics often, right? They're dealing, you know, oh gosh, these, you know, just being here with like the allergies and stuff, people who are just taking multiple antibiotics for sinus infections. Well, yeah. How many patients do have an annual sinus infection? Yeah. Yeah. Um, but I like to reassure patients, too, on the flip side of that where it's like this really appropriate reason to use this antibiotic. for sure your gut is more than likely going to do just fine. Yeah. Um even have some literature to suggest that even if we did nothing, even if we didn't give you a probiotic or, you know, that your gut will recover.
Your gut will recover. So, um you know, I like to again, it's like we're being mindful. We don't want to use antibiotics all the time because yes, that can cause disruption, but we shouldn't let that um we shouldn't let that let us be super afraid to take an antibiotic if it's really really appropriate to use one. So, um uh let's see what else do we want to say. You know, I think some of those are pretty obvious for our listeners. Oh, one area I think we should absolutely touch on, gut and hormones, hormone metabolism. Okay, we see a lot of patients in our clinic.
We do a lot of hormone therapy and support. And this is another area that again going back to our short list that we're kind of creating of conditions, you know, that we see in the clinic that absolutely we need to think about the gut. So, especially for women and irregular menstrual cycles, heavy menstrual bleeding, some of these so-called like estrogen dominant types of symptoms, right? The gut is heavily involved in that often, right? I mean, yes, there's other, you know, systems we definitely check in on and we often find need support, too, but um we have gut bacteria that actually make substances that affect how we metabolize hormones like estrogen.
So, we were talking about it in our case today even, right? Right? We can measure this enzyme called betaglucaronidase that is often we do see that when people have dispiosis or an imbalance and essentially what's happening is like when your liver which is a huge component of the the the digestive system arguably right right um is metabolizing those hormones in and other substances too. It's essentially kind of like using a little flag system. It's like tagging things where it's like this needs to go here. We need this back. we're going to send this out in the bile so that it can we can get rid of it through the stool, right?
Yeah. And estrogen is like that. And so if we have our liver tagging this estrogen to leave through the intestines because it's going again going out through the bile, if you have high levels of betagluconadase made again by that disbiotic bacteria in the microbiome essentially is like taking that little flag off. Yeah. and you get you're just reinfor you know and so I think that's another really um interesting connection that we can see with some of our ladies that are struggling to metabolize hormones. Yeah, that's fine. So, it's so interesting like all these different areas of the gut.
Um should we maybe transition a little bit to like what can we do? Takeaways. Um takeaways. What? Yeah. Gosh, this is the one I probably the struggle with the most is like what, you know, telling people what to eat. I still feel like it's just an area of our I don't It's so easy to tell people what to eat. It's if they'll do it. That's the hard part. Yeah. No, I mean I I I just in terms of like the scientific research on what to eat. We really don't have We have pretty poor research, but I think we have a fairly good understanding from a functional standpoint.
Yeah. People need to be eating real food. Yes. Right. So, yes. you know, if if you put something on your counter and it it hasn't molded or or gotten, you know, or spoiled, you know, after three or four days, probably that's not something we should put in our body. Um, so eating whole food, food without a label, uh, I think eating a diverse diet, but certainly paying attention to your body. I mean, some people can eat certain things and it makes them feel bad and so avoid those things, right? I mean, if you can't break down milk, don't drink a bunch of milk and have cheese, right?
Or seek out a good raw source of dairy regeneratively. Yeah. Raw milk. Yeah. Would also be good. Yeah. Go back and watch the because, you know, people Yeah. People hear people who hear that like don't don't consume dairy, they're like, I'm out. I'm out. It's [laughter] tough. Especially [gasps] in America. Yeah. For sure. I think um eating healthy meat. Yeah. Right. Right. I mean, I often say, I care more about what your meat was eating than what meat you're eating. Yeah. Because a lot of people say, "I'm trying to avoid red meat." I don't think we need to avoid red meat.
But I think we think about where meat's coming from. Absolutely. Um, and I think we should, you know, sometimes, you know, right, there's different areas of medicine where sometimes it's like the pendulum's over here and then something happens or we observe things that happen and then sometimes the pendulum swings a little too far. I feel like sometimes or that has happened with fiber, plant-based diets, right? every just got to eat all plants. And I'm like, nah. Yeah. But I don't know. I mean, you know, I think we do have a lot of good evidence that even like we were referencing earlier that the gut microbiome, I mean, fiber that is fuel.
Yeah. For the gut microbiome. And so sometimes I think yes, we have certain conditions that some people have where they have a more difficult time with fiber or fiber richch foods. But I don't think I think we should try to look at and address and support those things that we think might be causing the fiber intolerance. Yeah. And then come back to it. I I also think the microbiome can adapt too because we we've got patients that I mean they they don't eat a lot of soluble plant fiber um and they're eating a mostly carnivorous diet and they do really well.
And so we got to remember there's fibers in meat. you know, collagen fibers that bacteria can can utilize. Yeah. Um, it's probably more about being consistent. I mean, again, we think about our ancestors. Our ancestors would have eaten pretty much the same foods all the time. And so, uh, and a lot of people that travel, they have dispiosis when they travel probably because they're eating a bunch of food. Their microbiome is not used to. Sure. So, I think I do think the microbiome can adapt over time. So, having some structure in your diet, trying to eat the similar foods often, there's probably some wisdom in that.
Yeah. Yeah. For sure. polyphenols. So these, you know, compounds that we often find in like fruits, vegetables, especially like the ones with deep, rich colors, some good evidence for the microbiome really thriving. Yeah. So I think predominantly when people come in and they're like, "How can I support my microbiome? How can I increase diversity?" A lot of times people are like, "What probiotic should I take?" And I'm like, "Well, actually, it's more about food. Feed the garden." Which is your prebiotic. Yes. Yes. Yes. So, and again, I think a combination of just like how we treat supplements in the office, we try to prioritize food first, right?
But not going to lie, just like uh you know, a protein powder can help us reach protein goals. Sometimes a fiber supplement or fiber supplement can really help us with our fiber goals for people that that really, you know, helps. So, managing stress, I'd say another big thing that people can do, making sure you're getting adequate sleep. Yep. Movement. So, our our entic system needs Yes. that movement back and forth when we're sedentary. Yeah. Things don't move as well. So, I think though I think that I think there's two areas I wanted to circle back to with like constipation.
I think probably maybe two of the most common causes of constipation that we just generally see in the American public is probably lack of movement and dehydration. Yeah. I have been so tickled sometimes when I have clients who are like never really like the taste of water or you know I just like need something else and when I'm drinking and then they find like a filter or whatever it is that just really improve the taste they start drinking a lot more water and they're like my chronic constipation is gone. Right. Well again because that part of the colon's job is to reclaim the water and when it has to work extra hard you're passing on a really dehydrated stool that's hard to pass.
Yes. Yes. And again, the other thing I like to remind people when it comes to hydration, it's not just about water because water follows salt. So, if you don't have enough salt in your body, I mean, everybody's on these low salt diets. Well, unfortunately though, I think most Americans get too much salt because they're eating ultrarocessed food. It's a ton of It's like if it didn't have a ton of sodium in it, it's going to taste like cardboard, right? So, you know, I think yes, some of us who are, you know, it can be I guess we'll put it this way when people are really focusing on eating more of a whole foodbased diet.
Yeah. Then sometimes they you're right, they are not getting enough salt. Yeah. So, and and that's where I would say if if you feel like you're drinking enough water and you're still thirsty, you probably need more salt. Yes. That can sometimes be helpful. For sure. Um, any closing remarks? I feel like I have one more thing I want to say. I think that I think that I mean the biggest closing remark is we probably do need to circle back on a separate podcast and just talk about leaky gut it relation to autoimmune disease do a deeper dive into SIBO and its interaction.
There's a lot to unpack there. We really wanted this episode to just kind of lay some ground you know some framework just kind of lay the basics out. We are absolutely going to come back and start to like touch on some things like IBS and SIBO and maybe even like inflammatory bowel disease and and and again yeah I think it'd be great. But do you have anything else you want to say? Cuz I I've been saving something for the end. I'm done. [laughter] Um, a lot of times, and again, rightfully so, like I'm not saying this is wrong because again, I really appreciate when patients are coming in and they want to understand.
They want to understand what's going on with their body. They want to also understand it because when we understand things better, we make we tend to make better choices that help support to get us to a goal. But sometimes I see this in the functional medicine world where we get caught up in healing the gut, you know, um or like don't you get I get patients that are like, "How do I heal my gut? I have a leaky gut. How do I heal it? How do I do this?" And it's like the gut is I view it as like fluid.
And I know that there's things too that you know people don't like you don't have we don't have a lot of control if like you know kids bring home the stomach flu from school or you happen to get food poisoning or those types of things right and I just sometimes see this great deal of like stress of like I just got to fix my gut and what did we talk about that stress does to the gut? It's just going to keep making it more permeable and more inflamed. Right. So I think it's a humbling reminder that like yes, we want to acknowledge these things.
Yes, we want to address them. And ultimately, I think the goal should be we want to live our life and have lifestyle practices that keep our gut in good shape, in good function, right? But also acknowledging that like nobody's ever going to get to a place where their gut is bulletproof, never going to have anything negatively impact them. Yeah. I just think that's worth letting people know because I just see people sometimes like lamenting that like they if they just get to this one place everything will be fine, you know? Well, the the gut wants to heal itself and often times the body does, right?
The whole I mean I I I love the verse, you know, the way we are wonderfully and fearfully made. Yeah. Our bodies are designed to heal. Yes. And if we just take the insult away, often times that healing can can happen. And and let's not forget how fast the gastric mucosa can heal. I mean, everybody's bit the inside of their cheek before. It creates a little sore there. But a week later, it's gone. That is your body healing. Yeah. So, as long as you don't keep biting that same area over and over again, that healing can happen.
So, yeah, I do agree. I think I think sometimes people are looking for perfect. What do they say that uh better is the enemy of good. Don't let Yeah. Don't let be the enemy. Yeah. Don't let perfect be the enemy of the good. Right. So I would just encourage those people out there on their gut healing journeys to just think of it more as like hey my goal is to like just optimize my health so that my gut is working well balance but also knowing that like I am not bulletproof. Yeah. And things happen and again when I give my body not just the gut but the whole body the right environment and the right tools you can get there.
You can get back. So I think that's a good point to end on. Good job. Thank you. See you guys next time. Bye. [music]