Fixing The Root Causes Of Irritable Bowel Syndrome

there's really you know listening to the patient antibiotic use do they have a lot of ear infections they have a lot of strep throat did they get a lot of antibiotics uh what's going on in the family does anybody else in the family have any digestive issues um so just taking the time to get that history allows you to sort of play detective and try to figure out okay what are the things that are potentially playing a role in driving this and what might have triggered it and then personalizing you know diagnostics and treatment and everything else welcome to the doctor's pharmacy i'm dr mark hyman that's pharmacy with an ffa or macy a place for conversations that matter and if you've ever suffered from digestive problems from irritable bowel syndrome bloating and discomfort you better listen to this podcast carefully because it is a special podcast of the doctor's pharmacy which i call the house call series and i'm sitting down with my colleagues from the ultra wellness center in lennox massachusetts and today i'm joined by dr todd lepin discuss how we as functional medicine doctors tackle specific conditions we see in our practice every single day and i am going to focus today on irritable bowel because that is affecting so many people it's the number one reason people actually go to the doctor is digestive complaints it's a big problem and it causes disability and dysfunction and misery for so many people and it's fixable so todd todd is a great friend and colleague we work together for pushing on almost 30 years now long time we're still standing he's an extraordinary physician a leader and thinker in the field of functional medicine he graduated from dartmouth medical school he's board certified in functional medicine and he worked with me at kenya ranch for many years he teaches all over the world uh in various faculties and is just a brilliant functional medicine physician and honored to have him as part of our center here at the ultra wellness center so todd welcome to doctor's pharmacy again thanks mark it's great to be here okay so let's talk about this thing called irritable bowel syndrome what did we learn about it in medical school uh not much i mean we i think we basically learned that was one of those uh conditions where uh you sort of treat the patient and it's not serious you're not going to die from it and uh i can remember actually at the dartmouth uh we had dr almi and he was a um an expert in irritable well and back then it was felt to be more of a sort of uh neurologic sort of like stress related things psycho-emotional psycho-emotional and actually i'll tell you this is very interesting side story he did a a a a test uh where he took some medical students and was measuring the manometry of them and while he was doing the sigmoidoscopy uh he was measuring the tension in the in the in the colon and then he while doing the this you can only do this to medical students this is back in the 50s and he told them he goes i think i see cancer all of a sudden there was a spasm of the colon oh yeah and it was and it was like he wanted to evoke to see what it was what was going on with the irritable bowel they thought it was a lot of it was nervous related and which there is a stress component and uh so back then the a concept of irritable bowel was that it was all sort of in your head it's all sort of like we had a very uh fancy word for medical school we called it super tentorial which is a doctor's way of saying it's all in your head it's all in your head tentorium is that thing that kind of separates your top of your brain from the lower brain it was a joke but it was very pejorative and we often thought that these patients were malingers uh it was called functional bowel diseases yeah there's a lot of terms there was no real cause for it it was more psychological yeah and maybe stress related and these people are all emotional and upset turns out it's not so right and we and we call it syndrome right syndrome yeah when we say syndrome in medicine what do we mean it's a constellation of various symptoms and you know we we now we don't know what the hell is going on we don't know what it's like yeah it's like it's like you know chronic fatigue syndrome you know it's like you know how many different things can cause chronic fatigue it's like there's 23 flavors or how many flavors of baskin robbed and ice cream the same thing with uh 31. i used to scoop baskin robbins ice cream because that's from one of my jobs right right and then i don't know that'll probably cause irritable balls probably with all those artificial artificial flavorings and sugar so yeah so uh and you know nowadays we sort of classify irritable bowel into irritable bowel with constipation irritable with diarrhea and then mixed irritable valve that's how we're sort of you know putting an icd-10 coat on it um and and that's a way of conceptualizing it but there are lots of different things that play a role without question i think stress does play a role with irritable bowel and i think that you know stress can manifest in the body in so many different ways we talk we've talked about this when we talk about autoimmune conditions because oftentimes when we have a patient and some stressful event happens it triggers a host of things and sort of like a a ripple effect that goes on in the body and without question there is a stress component to some irritable bowel oh yeah i mean you've got your second brain and your guts there's more serotonin in your gut than in your brain you've got this whole nervous system that connects the two that is extraordinary complex and feeds back both ways so from the top down and bottom up so irritable bowel can cause irritable brain and your brain cause it will bow it goes back and forth right and you want to have a happy bottle of happy brain that's that's you know that's sounds like the key to a happy life happy bottles happy brain exactly exactly and then yeah and there is that it's an interesting thing that you talk about because you have that gut brain connection and it's like a two-way highway and they're bot they're basically communicating the brain's talking to the gut and the guts talking to the brain and then you also have the enteric nervous system and and some people sort of forget about the enteric nervous system and that's the intrinsic nervous system to the gut so literally if you if you sever the the spinal column and there is no connection to the gut in the brain the gut still works you can still you know poop uh fine if you if you sever the spine it's got a mind of its own right but you know todd i want to come back to what you said which is really important you said you know we categorize irritable bowels with constipation or diarrhea or whatever and there's a whole classification system that that is driven off of symptoms yeah and the difference between functional medicine and conventional medicine thinking about any disease is that it's not focused on the symptoms it's focused on the causes so just saying people have irritable bowel doesn't tell you anything about the cause it tells you they feel uncomfortable they're bloated they have diarrhea their bowels are weird they're they're uncomfortable cramping whatever the symptoms are is irrelevant when it comes to trying to figure out the cause i mean yeah okay you have a very little bowel but that's when you start to think about the problem in traditional medicine you name the disease you stop thinking right you know and our colleagues sid baker always had this great term says you know traditional medicine is naming and blaming you name the disease and you blame the name for the problem oh i know why your stomach hurts you have irritable bowel syndrome no that's just the name of the problem exactly but but he talked about thinking and linking which is functional medicine right yeah you think about the problem and the cause once you get the diagnosis and you link everything together to see what the factors are and there's no such thing as irritable bowel syndrome there's about syndromes like you said there's 31 flavors and each one is different and each one needs to be treated differently exactly exactly yeah that's that's a it's it's it's so so so true and there is this you know this web-like uh interaction in the body and it's very important to understand uh the whole inter uh connectedness of it it's very very important so so typically go to the doctor and you have a little bowel um what do what do they tell you to do well you know they they you know they'll they'll often tell you you know take some metamucil and i'll see you later that's that's more fiber drink more water yeah that's that's the sentence and yeah that's essentially what they're dealing with stress yeah that deal with stress yeah and they'll they'll the interesting thing this is i had a patient just the other day uh who i was seeing for um uh gi symptoms um it wasn't specifically here at a while and the patient's gi doctor said diet has nothing to do with your symptoms i mean it was it was unbelievable that a gi doctor told her diet makes no difference i i couldn't believe it i i just i like actually actually with a patient yesterday and she said i went to my gastroenterologist and i i wanted to show my stool test he says oh gastroenterologist don't look at stool i'm like well then who does if you're a doctor and i'm like you know that just doesn't make sense you don't look at what goes in and you don't look at what comes out how are you supposed to know what's going on in there right yeah and that's the difference in functional medicine yeah exactly yeah it's it really it's sort of it's a little bit mind-blowing and yeah you know you talk about like you know with going back to sid baker and sort of name it and and claim it kind of a thing wait a minute yeah name and blame it um is that and then tame it with a drug right and then i i always i always tell my patients you know i went from being a medical student to a student of medicine i'd like to always learn about things i love that and yeah and it's a very important thing that you have to remain open-minded and i think you also have to remain curious because every patient's different that's you know that's actually the joy of actually practicing functional medicine is it's not boring by any means it it's a it's you're constantly growing and learning and helping patients with the latest diagnostics the latest therapeutics to personalize their treatment and that's the fun part i mean correct doing functional medicine is a wonderful uh profession uh as opposed to regular mainstream medicine where most doctors are burned out you know they really are they're just they're unhappy they're they're burned out they're they're doing rubber stamp medicine you know i'll see you here's your proton pump inhibitor next next patient that's right that's it right that's it so you know doctor sees you you have irritable bowel they give you metamucil what else can they do sometimes well sometimes they'll give prescription medications i think one of the older ones that they used to do for ibs was zellnorm remember that one yeah they took it off the market because it was like really hurting people i think people were getting librium was the other one remember that that was that was a like a valium it was basically taking value is that is it valium for the gut yeah yeah and they're actually in certain patients uh there were some benefits from that because it did sort of calm down uh the nervous system i think uh anybody anybody taking value you're gonna feel it i feel good a couple of shots of tequila a little larger i feel good right but that's really not what we do with natural medicine you know you were talking before about how you never know what the issue is when someone comes in i was thinking about it it's much like forest gump medicine you know forest gum has a box of chocolates life was like a box of chocolates you never know which one you're going to get and i think in traditional medicine you got irritable bowel it's a thing you treat it all the same functional medicine is not like that we see some with irritable bowel and then we go wait a minute what is the cause of their irritable bowel and like what you're saying before it's very personalized right so how do we start to think about identifying what their particular issues are because before we can even treat it we have to understand the why and that is what i always say functional medicine is the medicine of why and regular medicine is the medicine of what what disease and what drug and and i think the big thing is time taking the time to talk to a patient and you know talk to a patient actually and listen to the patient that's wow listen to the patient that's that's actually you know that actually and sometimes the less i talk during a a an interview and a you know evaluation of a patient the better i do because you know oftentimes we want to jump in and ask this question they'll say something and we ask a question you know i think the in the average doctor's office this patient speaks for like 30 seconds the doctor interrupts them yeah no actually there was a study published years ago in the jama it was 18 seconds 18 24 exactly because you know we're trained to like you know probe the questions and you know they have their own sort of path of thinking going down that but i think the the big thing is you know we spend a lot of time listening to the patients and getting a history and a story and you know an important thing is an interesting thing in terms of ibs patients is that uh babies who have colic and they've actually looked at what is it that causes colic and babies you know you know yeah the latest evidence is that babies that have colic have high levels of klebsiella klebsiella is a bacteria and we know that klebsiella is actually associated with other inflammatory conditions and autoimmune conditions so klebsiella excess in the gut is actually associated with ankylosing spondylitis which is inflammatory bowel disease which manifests systemically with uh arthritic symptoms so getting a history of colic is important listening to uh the history of you know were they vaginally birthed were they breast-fed um what type of diet did they have as a kid and when did they get food introduced yeah yeah and all those things can play a role in terms of like early gluten free yeah exactly dairy yeah exactly and trigger leaky gut exactly and and just there's really you know listening to the patient antibiotic use did they have a lot of ear infections they have a lot of strep throat did they get a lot of antibiotics uh what's going on in the family does anybody else in the family have any digestive issues um so just taking the time to get that history allows you to sort of play detective and try to figure out okay what are the things that are potentially playing a role in driving this and what might have triggered it and then personalizing you know diagnostics and treatment and everything else it's it's all about personalization i think it's very very different what you're what you're saying this approach really is is being a medical detective absolutely and and it is relevant whether you're breastfed or for example or vaginally birthed because that affects your gut flora and the development for your whole life i mean i i recently read a study that showed bottle-fed babies have a high levels of a what we call a short-chain fat which is made by the good bacteria this one is called propionic acid now this is not such a good one and it's been shown to induce autism in animal studies and has been pushed with autism and add that is increased when you're bottle feeding when you breastfeed you get increase in butyrate which is the beneficial short chain fat that actually heals the gut absolutely it reduces inflammation does all kinds of good things so we think oh what's the difference bottle fed breast food that's not to make people feel guilty if they have to bottle feed you have to do it sometimes but you can fix that by making sure they have the right prebiotics and the right probiotics because breast milk has undigestable fibers that are prebiotics yeah and sugars that are prebiotics for the good bugs that aren't actually digested by humans absolutely knows that exactly and the other interesting thing about breast milk i mean you know if we could if we could um sort of bottle breast milk uh it's very very powerful stuff there's there's a thing in breastfeed called milk oligosaccharides and these are very very complex sugar moist uh sugar chemicals and they're actually so complex that for a long time science didn't even study them because we they were too complex it was like this you know a lego set there was this incredible building blocks and what they've done now there's a couple of companies one company specific out of europe that's actually synthesized one of the uh oligosaccharides in milk and there are actually hundreds of them um and these act like uh fertilizer for the good bacteria so these uh these these things that are found in breast milk are very very powerful things yeah yeah so powerful and so so we dig down into the story and figure out when did it start and what's connected to it did you have foreign travel because pop people often have post-infectious irritable bowel syndrome people can get it after antibiotics people can get after any kind of stress or trauma and you know and people don't realize that it's connected to so many different things so let's talk about you know what are the causes and then we'll go into sort of a case of how we would deal with this so what what are the what are the top causes uh that you found in functional medicine that are driving irritable bowel syndrome for people well a lot of irritable bowel also is probably misdiagnosed i think is sort of sibo i think a large number of and sibo is this diagnosis of you know small intestinal bacterial overgrowth so a bunch of people they're about have sibo exactly bad bugs growing where they shouldn't be in the small intestine exactly yeah and i i think that we're sort of finding that a lot of these people that we're diagnosing with this catch-all term is real they're really having potentially small intestinal bacterial overgrowth there are tests that you can do for that uh we do the that's also known as a food baby when you eat food and you get a big bloated tummy right after and as a food baby that's what sibo is right because what's what's happening is is the you know there's we have bacteria on our skin we have bacteria in our mouth we have bacteria in our stomach the small intestine large intestine most of them sort of live in the in the colon but there are times when the colonic bacteria start migrating upwards uh and they go higher up and it's sort of like you know invading a neighborhood yeah you know it's mostly sterile up there most it's yeah it's it's it's yeah it's it's not it's it's i think it was not necessarily that we always thought it was sterile even the stomach has bacteria right um and but it's just much less and they're all different kinds of bacteria so the the lower uh bacteria are more fermenters they they ferment things yeah and that's where we get i think i have talked about that and i uh i've seen this a couple of times the auto brewery syndrome where patients in fact i just recently had a patient fantastic uh case and he actually heard me uh uh on one of the podcast where i was talking about auto brewery syndrome so i i did a consult with him and he ended up going and buying a breathalyzer yeah and he confirmed that he has auto brewery syndrome because he was producing alcohol he was driving over the limit he was driving he was just short of the lift saves your money on beer for sure it was no it was actually quite interesting because he he actually was doing a very strict low carb no sugar diet and even with a really really good diet he was pushing making alcohol it's really quite interesting uh so yeah but anyway so uh you know talking about you know how do we how do we diagnose this so you can do uh stool testing i like the the the gi map test where you can do quantitative pcr for bacteria yeast uh fungi that's looking for the like the genetic material of the different yeah it's like csi yeah you see a csi it's it's i find it to be a very uh very helpful tool um you can also do the uh hydrogen methane breath test um although the thing about the hydrogen methane breath test is that i've had some patients who have significant you know irritable sibo type symptoms they're bloating and they're negative and they're negative and i think based upon my reading of literature is that they're probably producing hydrogen sulfide yeah uh and i think that when you just sort of get a history of you know they pass very foul smelling gas it smells like rotten eggs that's usually the the people that are producing hydrogen sulfide yeah people don't realize that you know cows just don't produce methane humans can produce methane exactly if you have this and we measure that coming out on your breath we measure hydrogen we have to take this drink and that's really a clue that there may be these bugs growing in there and they have to be treated directly and that can really help a lot of people oh huge huge amounts yeah and it's often missed it's it's it's very much missed and and and you also have to do the test properly uh because you know everybody produces small small amounts of hydrogen and methane it's just that you want it lower down in the colon it really doesn't become as much of a clinical issue um the other things to also think about in those types of patients is to make sure that they have sufficient amounts of stomach acid stomach acid is very very important uh at helping with the proper digestion uh so uh you can actually do uh testing for gastrin levels uh and i've been surprised at how many people have high gastrin levels so when you're you don't have enough stomach acid your body produces more gastrin which is the hormone to you know pump out more hydrocarbons like clogging a dead horse exactly absolutely yeah and i would i would venture to say that most people's uh issues are not high acid in the stomach it's low acid yeah it's low and we're taking more of these acid blockers which by the way also cause irritable bowel so they help your heart burn but they cause trouble and and now there are there is a role for short-term use of these these acid blockers like in the icu the studies have been shown they've been very helpful to prevent stress-induced ulcers and uh uh hospital-acquired pneumonia but they're really to be used short term and when you start using them long term they are very toxic yeah they are very toxic they produce uh increased intestinal permeability they cause malabsorption of nutrients uh vitamin b12 iron other minerals zinc yeah yeah and and they cause bacterial overgrowth and they cause osteoporosis absolutely oh yeah huge huge and i actually i i i am really surprised that these things are over the counter they really should not be over the counter you know i remember we've i've talked about this before but i remember when i was in medical school the rep they just came out and the drug group was like these are super powerful drugs you never want to give them more than six weeks they're designed to treat ulcers after six weeks you've got to stop them don't take them long term and now people eat them like candy all day long every day and i'm like this is not good and we see so many complications from that so if your irritable bowel is there and you have these acid blockers that you're taking there might be a correlation hey everybody it's dr hyman thanks for tuning into the doctor's pharmacy i hope you're loving this podcast it's one of my favorite things to do and introducing you all the experts that i know and i love and that i've learned so much from and i want to tell you about something else i'm doing which is called mark's picks it's my weekly newsletter and in it i share my favorite stuff from foods to supplements to gadgets to tools to enhance your health it's all the cool stuff that i use and that my team uses to optimize and enhance our health and i'd love you to sign up for the weekly newsletter i'll only send it to you once a week on fridays nothing else i promise and all you have to do is go to drhymon.compics to sign up that's drhyman.com forward slash picks p-i-c-k-s and sign up for the newsletter and i'll share with you my favorite stuff that i use to enhance my health and get healthier and better and live younger longer now back to this week's episode so we talked about sibo and we talked we could talk about how to treat that but essentially it's killing the bad bugs and re-seeding the gut and and what other things are driving your mobile besides that well also you can also uh potentially have uh problems with uh part of the intestine that causes peristalsis so normally you think of the the gut is like this conveyor belt it's always moving things through so you eat and within about 24 hours everything should sort of move through and there are some patients especially with the patients who have problems with constipation that will have problems with uh motility or really motility disorders and there's a test it's not moving down not moving down and there's a there's a part of the intestines which is called the migrating motor complex and you can actually test for antibodies against the uh the migrating motor compass it's called ibs sure test and i'll do that it's almost like an autoimmune thing yeah it's it's like a little bit like a paralysis if you will or a weakening of the of the gut and we talked about that earlier how um you you in some cases and you'll have patients who have uh lyme disease i actually had a very good integrative gastroenterologist who brought my attention to this is that he had a lot of patients who had refractory sibo yeah so they you know sibo's was one of those things where it sometimes can come back and oftentimes does come back and what he was finding is that someone's more difficult patients with refractory sibo actually had underlying lyme disease and lyme disease affects the nervous system yeah he tied the two together uh because there is a as a paper it's called bell's palsy of the gut and uh in fact uh bell's palsy is a where you get facial paralysis yeah and i'll never forget this when i was in my private practice i had the first time i uh saw a real acute a case of lyme disease the patient presented with bell's palsy so her face was paralyzed and i did testing on her and the patient had acute lyme disease and that is one of the known complications and it's thought that also that lyme disease can actually affect the gut and you get paralysis and and decrease motility of the gut yeah so so that is a very important point because you know there are the typical things that go on food sensitivity yes gluten dairy some people react to the chemicals in food that are food food additives food colorings food colorings sugar alcohols people emulsifiers emulsifiers all these things that are in our junk and processed food do have a huge impact on people uh there's obviously the sibo some people get parasites yeah little little microscopic hitchhikers yeah and there's and there's one called blastocystis which is really common it doesn't it doesn't cause a horrible disease but it can cause your bowel about 30 percent of people with ibs oh yeah i have this i i i'm going to venture to say that i have picked up a lot of these i call them little microscopic hitchhikers and when you actually look in the in the mainstream literature they you know they basically say that you know a lot of these you don't need to treat it so there are times when somebody can you know there's dientamoeba histolytica and uh blastocystis and sometimes endolymex nana and sometimes people will have these and they'll have a small amount of them and they may not cause any symptoms whatsoever but if i find them in the in the stool test and patients are having symptoms i treat them yeah absolutely and then there's also other things people have like enzyme deficiencies we can see on stool tests they're not digesting their food well yep um and also you know for me i i had terrible irritable bowel you know almost 30 years ago it was from mercury poisoning because mercury affects all your enzymes it basically interrupts the enzyme function of many different enzymes throughout your body including your gut and until i got rid of the mercury my irritable bowel wouldn't go away no matter what i did yeah i just ate turkey and broccoli and brown rice for six months and nothing worked and that's and so you have to keep being a detective and thinking about what are all the variable causes and we look at the stool testing we look at breath testing for bacterial growth we look at uh organic acid urine testing you see there's markers of bugs in there uh and we we sometimes dig down deeper to look at things like metals or lyme or other tick infections so there is a real deep thinking about what is going on with this person and it's guided by their history right exactly yeah it's it's and it's it's personalized it really is it's it's you know it's it's totally personalized and it takes time to figure that out yeah uh and you know sometimes it it may take several visits i mean you you you and i have had patients where we've been seeing them for a long extended period of time and they're you know they're getting they make some progress they get better uh they may backslide they may you know then they'll have the incremental uh things so we sort of uncover the as you say the layers of the onion yeah that's true i i had a very bizarre case once they just reminded me of who was suffering terribly from digestive issues for years and years was overall systemically inflamed and it turned out he had bibisia which affected his gut wow he also had histamine intolerance that's another one yeah there are histamines in food and and so he we put him on a low histamine diet we treated his his um his babies and his symptoms got better so sometimes it's a little bit of a roundabout way to think about it but um what what case have you seen in in your practice that have sort of stood out for you around your irritable bowel well i recently had a patient who came in with a diagnosis of irritable you know that was that was the official diagnosis and uh interestingly she gave me through the history that you know her symptoms seemed to have been triggered when she had lyme disease and her lyme disease also was complicated by pots which we've talked about before which is postural ortho orthostatic tachycardia which basically means that you have autonomic nervous system dysfunction as a relationship to lyme so that sort of means when you stand up you get dizzy yeah when you stand up you get dizzy and your heart starts going really fast and uh so you know there are certain a couple of things that you know that uh make me think about lyme disease so when i have a patient who's got pots and sometimes people just come in and that's their only their only diagnosis is pots i said okay well why do they have pots i love medical terms postural orthostatic hypotension which is called pots it sounds like a fancy diagnosis what does it mean it means when you stand up your blood pressure drops doesn't tell you anything about why or what caused it and it's just it's like so frustrating to me that nobody keeps thinking about what's going on here with these patients so they can actually fix the problem right right so so this lady had this history of of lime and uh and pots and then she uh ended up having uh cancer of the uterus and uh went through radiation she was supposed to get like 25 rounds of radiation she had to stop at 12 because she developed diarrhea and called radiation colitis radiation colitis radiation and righteous exactly and um believe it or not they know the doctors who were treating her said oh that has nothing to do with your symptoms i mean they they literally you know they didn't want to they didn't want to you know admit that it was from the radiation exactly exactly yeah yeah and then she came in and she actually had had some testing done uh previously and what i would what and i think the doctor who actually did the testing didn't know how to interpret the test properly but the patient's cal protection was elevated so calprotectin is a a biomarker in the gut it's i call it like crp of the gut so we have this this compound which is called a high sensitivity c reactive protein when it's elevated it uh is a biomarker of systemic inflammation and it's also highly correlated with heart disease and um calprotectin is found in the gut and it's sort of like the crp of the gut so when you see that you see it's high inflammation yeah exactly so it tells you and usually you know for classic you know what we call irritable bowel syndrome you don't usually have inflammation per se there's not really dramatic inflammation there's dysfunction but there's not inflammation so her irritable bowel was actually partly inflammation and and i think that was uh uh one of the big things that was uh driving it the other thing in this particular patient is that she had on her testing uh undetectable acromancy mesenophilia that's a big word accurate right yeah all right so so this is a it's a it's a mucus-loving bacteria and what we found is that higher levels of this is correlated with leaner body mass less chance of obesity less chance of diabetes and uh it's also uh you want to have higher levels of this because it's a protective good bug it's not it's not it's not a probiotic immune disease yeah let's interests have cancer yeah so and it's not a it's not a bug that you can go out and get a pill for at least not yet uh eventually we might uh because it's so beneficial but what we find out is that this particular bacteria feeds on uh fibers specifically polyphenols um so those polyphenols are those compounds that are uh phytonutrients found in lots of colorful fruits and vegetables things like pomegranate and green tea and cranberries cranberries yeah so your little bugs like cranberry pomegranates and green tea exactly they love that stuff this is their you know i called the miracle girl you know that's a miracle you put this stuff on there and the good bugs flourish there's a fairly new understanding you know because we thought okay you need prebiotics you need probiotics but i think the polyphenols are also critically important uh to optimizing your gut flora the three ps yes exactly and and the the other thing which i always come back to when i when i think about the digestive tract is is uh it's a beautiful visual is the rain forest and for anybody who knows about rainforest rainforests are full of biodiversity there's lots of flora and fauna there's frogs there's birds there's all different you know plants insects worms and the more biodiversity that you have in your personal internal rainforest the healthier you're going to be and there's there's there's tons of studies that have shown this and it's a it's it's non-linear it's very very complex because there's this whole ecosystem and there's this cross-feeding and interaction that happens when you have a diverse uh internal rainforest yeah and so trina i was talking to a professor at harvard who's a psychiatrist and also runs the department of nutritional psychiatry and she's written a book uh called this is your brain on food talking about the microbiome and its effect on psychiatric illness absolutely so we we used to think that you know the crazy person would have the gut problems turns out the gut problem people have the crazy thing upstairs because of the gut thing and fixing the gut fixes the depression anxiety ocd all these crazy things that we thought of our psychiatric illnesses yeah turns out they're really related to the imbalances in the microbiome and the lower diversity and western societies have increasingly lower diversity oh huge huge yeah exactly and it happens very very early on is and what typically will happen is is is um you know there are there are some people that you know they're they're you know they're very picky eaters and they will they'll be eating the same food over and over and over and um you know i always tell patients that you know you want to try to increase your intake of diverse fruits vegetables you know try to eat and see right now in the berkshires you know we have lots of great uh vegetables that are available that you may not get year round um and you know eating uh i call it you know you want to eat a crayola crayon box the more color you have in your diet the healthier your diet's going to be and i want to come back to something you said before about this inflammation in the gut there's a whole new phenomenon we call pre-inflammatory bowel disease so we thought irritable bowel wasn't inflammatory it turns out even if you can't always detect it it tends to be very inflammatory and there are there are cases like you saw of people with this pre-ibd so it's like pre-crohn's or pre-colitis yeah it's not like one one night you wake up and all of a sudden you've got crohn's disease yeah and so there's this level of this marker we check and it's often elevated and people have you know not full-blown crohn's these but something's going on in there that's driving inflammation and you have to deal with those factors exactly yeah exactly so so this patient she also had elevated gluten antibodies right so she was low acromancia she had yeah elevated elevated gluten antibodies and there's a high cal protectant yep and and so this is a sort of a perfect setup for having a messed up gut absolutely yeah yeah so how would you take care of this patient then who came in with the gluten issues the low acromancia and the cow protector well i mean to to address the inflammation and by the way these are something that your traditional doctor will never look for right that we usually uh look for in functional medicine at the ultra wellness center sort of standard operating procedure for us to really look at these things yeah so so you know to treat inflammation i always like to check the omega-3 fatty acids can we have low essential fatty acids you're a set up for inflammation so in this particular patient that patient had sub-optimal omega-3 fatty acids which relate to eating cold water fish so i got her to take some supplemental omega-3 fatty acids had her increase her fish intake uh i used an anti-inflammatory supplement called ultron flamex which has uh has a powder curcumin and other things to help decrease inflammation in the gut ginger rose exactly ginger and rosemary exactly and then also used in terrigam which is a immunoglobulin um that helps with uh patients who have uh sort of a diarrhea type uh that's actually a prescription medication so tell us more about what what is this immunoglobulin stuff because you hear a lot about it and yeah it's it's serum bovine uh derived uh immunoglobulin and it's basically colostrum yeah you can think of it's like colostrum i mean yeah colostrum is you know classroom is that stuff that mother's milk that is before the milk uh comes on and it gives immunity to the baby exactly yeah it's it's passive immunity so it's the mother's immune system that's passed down to the child so which is really quite amazing when you think about it from an evolutionary standpoint that the mother's immune system has evolved and learned what to deal with and how to deal with it and then that immune system gets literally transferred in the breast milk to the baby until the baby can actually develop its own exactly exactly and and the interesting thing is our immune system has to learn it's got it's got to be edge it's got to go to school yeah and and that's why you know when you see these little kids who are crawling around on the ground and they're putting stuff in their mouth we're developing what's called mucosal tolerance it's the immune system learning to deal with the planet earth and it's you know it realizes that okay you're going to be around a lot of these things you don't want to overreact to it um and so you know we always talk about you know what is a healthy immune system well a healthy immune system is a tolerant immune system yeah it doesn't overreact or under react exactly that's that's the key thing and i always say to people i want a strong immune system well if you have a too strong immune system that's called autoimmune disease right when your body's reacting to everything and it's like overreacting so uh having uh tolerance and mucosal tolerance is really really important and the other thing which i and some of the lectures i do and i i like to emphasize this is you can think of you know we have the boston symphony orchestra and unfortunately tanglewood is is not not open this season because of covet but in the boston spinny orchestra you have the conductor and the conductor you know balances the the the woodwinds and the strings and everything and they sort of keep everything in balance and in the immune system we have uh cells called the t-reg cells and the t-reg cells regulate the immune system between the various parts of it so like make sure it's not too hot not too cold exactly exactly and guess what helps with t-rex cells fiber what fiber yes so that when you're eating lots of fiber you up regulate your t-reg cells other things that can do that vitamin a can do that too but but fiber is probably one of the biggest things that helps with the t-reg cells yeah and functional medicine is really uh practical too because when you have a patient with any condition particularly with gut issues which is often driving so many things so even if you don't have quote irritable bowel a lot of health conditions are driven by imbalances in the gut like we talked about psychiatric issues heart disease obesity but we have a very specific framework called the 5r program which we use to methodically treat and restore gut function and we've been doing it for decades even before people called it the microbiome our goal is to really optimize the microbiome as a way of treating all sorts of diseases so how how would we do that in this patient obviously you got rid of the gluten right yeah yeah obviously in in a patient in a patient to uh decrease inflammation uh you can decrease the foods that you know typically uh drive inflammation so things like trans fats can drive inflammation sugar drives inflammation um dairy big thing especially cow's milk uh sheep and goats tend to be less inflammatory i'm not sure why that is the a2 casein oh etc okay that's it there you go yeah a1 casein is very inflammatory which is all the modern cows all the heirloom cows and sheep and goats still have a2 casein which is less inflammatory yeah tends to cause less digestive issues for people yeah and then gluten is a big driver and then other things that um you know are found in foods uh like we talked about things like emulsifiers an artificial process processed foods exactly if you can't read it on a label don't eat it yeah yeah you don't don't need it um another one which is i'll mention this is uh titanium dioxide yes i was just reading about that exactly tell us about that yeah it's bad it's the thing that they add to food to white give it even white to whitening and they'll use it in a lot of products gums they use it and such it's a lot of vitamins you get at the drugstore too exactly and and titanium your body does not like titanium it's not it's it's a metal and uh your body can react to it and it's it's almost like a nanoparticle metal that you're putting in the body and uh it's been shown to uh the gut does not like it yeah one more reason to not eat processed food exactly all right so we've gotten removing the foods we're removing these processed ingredients removing trans fats gluten dairy other food sensitivities i had a patient for example i diarrhea for years and years around she had a sensitivity to eggs it wasn't an allergy she got rid of the eggs in her diarrhea in a way yeah you know and and then there are some times where you know doing a strict elimination diet to try to tease out because food is complex there's lots of things when you're eating food there are also some some patients that you know you've probably done yourself where sometimes you've got to put them on what's called an elemental diet yeah you basically give them that pre-digestion pre-digested exactly and that helps to sort of calm down and quiet the gut in fact mainstream doctors will do that for patients where they'll uh they'll actually put them on parental uh nutrition where they just give them it through the sort of rest the gut yeah i mean we're gonna be having a podcast with one of our nutritionists we're gonna be talking about the elimination diet and why we do it and how we do it and there's lots of different versions particularly for ibs the fodmap diet there's a specific carbohydrate diet there's a traditional elimination diet so i think i think this is a in a really important thing is to get rid of the things that are causing the problem and then we look for parasites and other bad bugs sibo breath testing so we actually clear out all the bad stuff yep yeah take out take out the bad and put in the good what's the next step for how to repair the gut on the 5r program uh well you can you can uh re-inoculate you sometimes you can use probiotics along with prebiotics we call that symbiotics though the big thing you got to watch out with that number you've probably seen this is if you add that in too soon you can actually sometimes flare up bloating symptoms yeah it's like a war between the good guys the bad guys you got to clear out the bad guys first i caught the weeding seeding and feeding program first you gotta do the weeding then you gotta see the good guys and then you gotta feed them yeah exactly yeah that's exactly right and then the other thing that's also important just that sort of helps with digestion is and and i've been using this more and more is stimulation of the vagus nerve so the the vagus nerve um we have the autonomic nervous system in the body and there's like this my analogy is the the gas pedal in the brakes and the gas pedal is a sympathetic so it sort of gets things going and the brakes sort of slow things down so the stimulating of the vagus nerve is resting and digesting and that's what you want to be doing you want to be in a relaxed state when you're when you're digesting your food um and we tend to have a sympathetically driven society you know yeah running going we're you know always on the go so people say prayers or grace before eating they calm everything down yeah right yeah and we just kind of eat on the run eat on the car yeah people walking down the street and we we're all guilty of that because we're watching tv yeah that the worst thing is actually i call it unconscious eating you know it's like you're sitting in front of watching a movie and you've got the popcorn all of a sudden the big bowl is gone well they've actually done those studies they literally have a secret trap door on the bottom of the bowl and they like fill it up from the bottom and people just keep eating and eating exactly unconscious eating it's like it doesn't stop exactly exactly yeah okay so so the five hour program is basically remove the bad stuff basically replace the things that are missing digestive enzymes enzymes and prebiotics re-inoculate and then repair which is prepared the next phase which is how do you fix a leaky gut right yeah and that that's you know you talked about butyrate butyrate is one of the things that's very helpful for leaky gut and i've been using that uh in in supplement form yeah uh i also encourage you know fiber fiber use and um glutamine can be very helpful aloe this can be really helpful uh quercetin or other other things vitamin a zinc zinc yeah zinc zinc in the form of zinc carnosine is also there's some really interesting studies on that with leaky gut um because when you take things like advil or aleve those things cause transient leaky gut so you're gonna have you're gonna develop leaky gut and for people who are taking them chronically they've shown that just taking zinc will help repair the gut with the nsaids so it's really a very specific methodology of diagnosis and treatment and and you know the hit rate is pretty high on this i mean i i think you know people come in with these chronic lifelong digestive issues and i just talked to a patient yesterday and she had been struggling struggling and struggling didn't know she had a parasite she had bacteria growth she had all these issues and within a couple of weeks she's back to normal and i think people are just sort of shocked and one of the things used in this patient is as a gut shake that kind of combines a lot of these things that helped grow her akkermansia exactly yeah so the gut shake is is full of polyphenols contains uh things like cranberry uh pomegranate uh maca uh matcha matcha matcha mug i call matcha green tea matcha matcha right right matcha nutmeg yeah and it's got the immunoglobulins which are yeah you talked about that help kind of regulate the immune system in the gut right and prebiotic fibers probiotics yeah and and again as i call this sort of like you know miracle grow for your rainforest it just helps with biodiversity it helps with this uh flourishing of the good but good guys which which have their own way of of keeping things in check it really is so uh for those listening who have irritable bowel who've been suffering for a long time without help there is help you don't have to suffer it's actually not that hard to fix it's sort of embarrassing how easy it is once you know what to do but most of us in medicine were not trained on how to approach this systemically or systematically and that's what functional medicine is it's a systematic approach that looks at the causes and then restores normal function hence the nerve name functional medicine and we've been doing this at the ultra wellness here for gosh i don't know decades now uh with all of us together we probably have 65 years of clinical experience and we all are faculty and teach all over the world so i think your you know your your stories and my stories just you know go back so many years and help us really know that we have a way through this and people don't have to suffer so people are listening and struggling i encourage you to get help to a functional medicine doctor here at the ultra wellness center we're doing all virtual visits now people well we also you can come in for sure but we do virtual so you can get new patient virtual consults uh and and we're really happy to help anybody who needs help because this is a terrible problem to suffer with yeah and there are answers and there's a way to figure it out and it ain't that hard and i personally have suffered from it so i get it and it's just no fun so i think todd you are a wealth of knowledge and i'm so glad to have you back on the podcast uh and i'm i'm just wondering out there if if you struggle with this please uh share your story with us leave a comment and subscribe subscriber ever get your podcast and um uh we would love to have you share this with everybody because i think there's a lot of people out there with here will bow and then uh we'll see you next time on the doctor's pharmacy we want to have everyone have happy guts happy gut happy guts

Channel: Mark Hyman, MD

Views: 216,693

Keywords:

Id: UPJnhvu4S5s

Length: 46min 13sec (2773 seconds)

Published: Mon Aug 10 2020