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Ep. 455 Microbiome Masterclass: Secrets to a Healthy Gut

  • Team Cynthia
  • Apr 9
  • 83 min read

We have a mashup episode today, with several experts diving into the critical role of the microbiomes in our bodies.


In this episode, Dr. Colleen Cutcliffe explains why fiber is essential for gut health and the challenges of cultivating anaerobic probiotics outside the body. Dr. Elisa Song discusses the impact of antibiotics on children’s gut and mental health. Dr. William Li highlights how plant-based foods nourish gut bacteria, metabolism, and mental well-being. Dr. Nathan Bryan dives into the role of the oral microbiome in nitric oxide production, and Dr. Vincent Pedre explains how glyphosate contributes to leaky gut and health issues and examines how alcohol and environmental toxins impact weight management. 


Join us for today’s in-depth exploration of how our microbiomes impact digestion, health, and overall well-being.


[00:02:18]- [00:25:22] Dr. Cutcliffe highlights the importance of dietary fiber for supporting gut microbes, metabolism, and overall health and explains the challenges of growing anaerobic probiotics like Akkermansia outside the body. 


[00:12:17] - [00:24:28] Dr. Song highlights the often overlooked effects of antibiotics on gut and mental health, emphasizing the importance of educating preteens, teens, and young adults about how their daily choices impact their microbiome, brain function, and long-term health. 

[31:30]- [00:43:01] Why it is essential to understand how antibiotics and birth control impact the gut microbiomes of children and the importance of nurturing their resilience and restoring balance in their microbiomes over time.


[00:01:46] - [00:24:29] Dr. William William Li clarifies how bioactive compounds in plant-based foods feed gut bacteria, benefiting metabolism and mental well-being. He also highlights the importance of a healthy diet for gut health and explains how colonoscopy prep temporarily alters the gut microbiome.


[00:13:46]- [00:21:51] Dr. Nathan Bryan explores the crucial role of the oral microbiome in nitric oxide production and how mouthwash or fluoride products can disrupt that process, leading to higher blood pressure and reduced cardiovascular protection.

[00:35:04]- [00:37:17] How, even though antibiotics and antiseptic mouthwash can disrupt the oral microbiome, the microbial communities can recover when given proper care and nutrition.


[1:56-27:39] Dr. Vincent Pedre highlights how glyphosate disrupts the gut microbiome due to its mineral-binding and antimicrobial properties, leading to imbalances, leaky gut, and numerous health issues.

[48:00- 1:02:15] The role alcohol, gut bacteria, and environmental exposure play in weight management and gut health, and how certain bacteria may lead to increased caloric extraction from food.


 

“High-fiber foods are important because they feed the strains (of gut bacteria) that metabolize fiber and convert them to integrate with our own signaling system.”


-Dr. Colleen Cutcliffe

 

Connect with Cynthia Thurlow  


Connect with Dr. Colleen Cutcliffe


Connect with Dr. Elisa Song


Connect with Dr. William Li


Connect with Dr. Nathan Bryan 


Connect with Dr. Vincent Pedre


Transcript:

Cynthia Thurlow: [00:00:02] Welcome to Everyday Wellness Podcast. I'm your host, Nurse Practitioner Cynthia Thurlow. This podcast is designed to educate, empower, and inspire you to achieve your health and wellness goals. My goal and intent is to provide you with the best content and conversations from leaders in the health and wellness industry each week and impact over a million lives. 


[00:00:29] Today, I have the joy of bringing you a microbiome masterclass with both acclaimed scientists and researchers and physicians, starting with Dr. Colleen Cutcliffe, Dr. Elisa Song, Dr. William Li, Dr. Nathan Bryan, and Dr. Vincent Pedre. Today, we are going to walk you through the basics of the gut microbiome, providing relevant insights to the things we need to be watching out for and tips and tricks for supporting our health as we navigate middle age and beyond.


[00:01:06] I'd love to start the conversation. I believe most of my listeners are familiarized with the gut microbiome, but perhaps not with how we start off when we're born, that many of us are inoculated as we're going through a vaginal delivery. I know many people have had C-sections. I had two because I had two big breech kids. But understanding that this is usually the first time that we're getting this swash of exposure to the human microbiome through our mother. 


Dr. Colleen Cutcliffe: [00:01:38] Yeah, absolutely. Well, I think it's hard to turn anywhere these days and not hear something about gut health or the microbiome and how important it is for us. And we're really realizing it's at the core of all of these different systems in our bodies. And so, I think about how in exercise and fitness, at some point there was this, aha moment where people are your core. If you could just strengthen your core, you could do any exercise you wanted. And I feel like we're having that parallel now in the body, which is the gut is at your core. If you could have a strong gut microbiome and strong gut health, it will really impact all these other systems in your body. And to your point, it's not about necessarily just today, but also where did we start? 


[00:02:16] And all the changes that are happening to our microbiome as we grow, as we age, and as we go through these different stages of biology. And so, it all starts actually in utero. So, we used to think that there were no gut microbes. When you're in the womb, there's nothing in there except for no bacteria or anything like that. But what we're realizing is that may not be true. There might be some things already starting to happen there, but certainly your first real influx and exposure to the microbiome is in the vaginal birth canal. And so, if you deliver a baby vaginally, it gets exposure to all of your vaginal microbes. 


[00:02:52] And we know as women that our vaginal microbiome and vaginal health is something that is really important, but it's particularly important during pregnancy and during delivery, what are the microbes that are there and making sure that the baby gets those exposures. And so, the baby is born via C section. They don't get that initial seeding of all these different microbes. And so there have been really extreme scientists who have had C-section babies and then immediately wanted a vaginal swab all over them to try to mimic what it would have been like to have a vaginal birth. I think that eventually we will get to a place where we can do something a little bit less dramatic than that. But, that's really where it starts. And then from there on, it's all about increasing the diversity of your microbiome. From mother's breast milk to the first foods that we eat, to all of our lifestyle and exposure. It's all about how do you diversify your microbiome to give it as many different functions as possible. 


Cynthia Thurlow: [00:03:45] Yeah, and it's so interesting to me because I have teenagers now. I'm now in this fun stage. I've loved every stage of being a parent, but helping them understand, if they get a round of antibiotics, what the net impact can be on their gut microbiome. And right now, they think, I know nothing. This is the teenage years where their parents know nothing. And helping them understand why it's so important, that lifestyle piece. 


[00:04:07] So, I'm certainly not suggesting there's an appropriate utilization of antibiotics therapy used judiciously and for the shortest duration as possible, but helping them understand that they're at a stage in their lives where they've got a much more vibrant gut microbiome than perhaps the stage of life that I'm in, where our gut diversity starts to shift and change as we are getting older and perhaps talking about what are some of the natural fluctuations that you will see when looking at the research throughout a woman's lifetime. Obviously, the younger we are, we have better diversity, we have sex hormones that can play a huge role, especially estradiol, in the gut microbiome, and how this starts to change as we're getting older. And by this, I'm sharing this because I find this fascinating. This is not information I learned in undergrad or grad school. And so, I think it's the more that we understand, the better we can prepare and to ensure that we are making the adjustments in our lifestyle that will make a large impact on our gut microbiome. 


Dr. Colleen Cutcliffe: [00:05:11] Absolutely. And I really love that you are doing this podcast and getting everybody educated, because the fact is, none of us learned about it in school. And the reason is because this is actually a new science. Things like probiotics and yogurts have been on the shelves since the 70s. But actually, microbiome science, if you look on PubMed at all the publications that have come out and you just type in the word microbiome, you'll see that before 2005, it's literally at zero. And then you see this really logarithmic exponential growth of all the papers being published. And it's because actually, DNA sequencing technologies are what's enabled us to really survey the microbiome. And so, now it's really opened up this whole new part of health for us that we really didn't have access to before. 


[00:05:52] So, none of us who went to school earlier than 2010 were really even aware of this. And certainly, even now, there's just more new information coming out. I also have teenage daughters, and so I think that or I also have teenagers mine are both girls. I just laugh about how little we now know. There was a time when we knew everything. Now we don't know anything. And later, hopefully, they will come back and realize that we might know a thing or two. But I think at the end of the day, it's really hard for a teenager to be motivated to think about their health, because we can all remember that time where we could eat or drink whatever we wanted to and we didn't have to think about it or worry about it. 


[00:06:29] And so when you're in that stage of life, you're really not thinking about your future self. And, “Gee, how do I set myself up for future health?” Because you can't even fathom not being totally healthy. And so, I think to your point, that's where you're sort of at your most diverse, where you have the most functions in your microbiome. And what happens to us over time is that we do start to get depleted in that diversity. And it happens for a variety of reasons. One, to your point, is antibiotic treatment. That is one of the most potent ways to essentially kill all of the microbes in your body. And to be very clear, I'm not antibiotic-er, people should take them, they save millions of lives. But there is overuse of antibiotics that's happening. 


[00:07:11] And I think that it's really important to know that it doesn't come without a cost. When you take antibiotic, you really are killing off your entire microbiome. And we know that actually after antibiotics, it takes a little while, but you will reconstitute a microbiome. But it's becoming pretty well known that that microbiome you get after the antibiotic treatment is oftentimes not the same microbiome that you had before. And more importantly, it tends to be a microbiome that helps you hold calories. So, farmers have actually been using this tool for decades where they give their cattle antibiotics, not because they're trying to disrupt their microbiome, but they noticed that they gained weight if they gave them antibiotics. 


[00:07:48] And there have been studies shown in children where if you give kids a lot of antibiotics and infants a lot of antibiotics, they are more prone to type 2 diabetes, obesity, even things like allergies and asthma, ADHD, celiac disease. They're more prone to all these diseases later on life because that new microbiome is really not the same as the first one. We know that our diet is the second biggest way that you can change your microbiome. And so, the food that you eat is literally the food that you're feeding to your microbiome. And so, you are selecting who lives and who doesn't, based on who you're nourishing. And then there are things that are outside of our control that really affect our gut microbiome. So, we know just simply as we age, we start to become depleted. 


[00:08:29] We know that when we go through periods of intense stress, we start to become depleted. We know that when we travel our circadian rhythm gets disrupted, day becomes night becomes day, we start to lose diversity in our microbiome. And for us women, when we go through menopause, we lose diversity in our microbiome. So, these are all just things that are part of living that can cause us to lose diversity. And that loss of diversity is super important because what it means is a loss of functions. So, all those things that your teenage body is able to do really easily, you now can't do those anymore. And so that's why, as we age, we start to feel like everything's sort of falling apart. Some of that is going to be the way it is, but some of it can actually be rectified by just giving yourself back these microbes. 


Cynthia Thurlow: [00:09:11] Yeah. And I think it's so exciting because this is a conversation designed to be empowering and informational, not to be scary. Because let me be clear, and I agree with you 100%. When antibiotics are used judiciously for an appropriate duration, it can make a huge difference in many individuals lives. I always say with a ruptured appendix it saved my life but I had six weeks of antibiotics and antifungals and I think even five years later, I'm still having to continue to work on replenishing that gut microbiome. And I love that you tied in the nutrition and stress and understanding that when we get jet lag, which some of us do a better job with jet lag than others, I have a much easier time going east than I do west. 


[00:09:55] And then also the changes that happen as we're making that transition from perimenopause into menopause. Let's back up and talk a little bit about bacteria. I always say microbiology ruined my life in a good way, but it made me very aware of the fact there were a lot of species and microorganisms that were out there that I was just completely unaware of. Let's talk a little bit about both anaerobic and aerobic bacteria because they play an important role in the gut microbiome, they play an important role in our digestive system. And there are certain areas where certain types of bacteria thrive and others do not. And sometimes when you get an overgrowth of nonbeneficial bacteria, that's where you can start seeing some problems. 


[00:10:38] So from a high level talking about these basics, because I think it sets the stage for talking about specific organisms later in our conversation.


Dr. Colleen Cutcliffe: [00:10:47] When we think about just the biology of our bodies, you start to learn and understand that there's different parts to the system that are environmentally really different. It's like going for a hike through different terrains. You're really in totally different landscapes from the beginning to the end. So, it starts kind of with the air around us, which has a ton of oxygen in it. And when we eat food, there's certainly oxygen in our system, oxygen in our stomachs. But after our stomach starts to digest that food and we start to talk about the intestines and where these microbes are residing, your food starts to go down the intestinal tract. And so right on the other side of the stomach, there is still some oxygen there. 


[00:11:23] But actually, as you traverse down this track, this intestinal track, you start to get more and more of an oxygen free environment. And by the time you get to the distal colon, which is where the gut microbiome is, there's actually no oxygen there. And so, what happens is that you have these microbes that are on the other side of the stomach that are doing a lot of your work for you. A lot of the Lactobacillus and Bifidobacterium strains that we see on the market today, they are all along the track there. And so, they can be grown in the absence of oxygen. They're not so sensitive. 


[00:11:52] But when you get to the gut microbiome where there's no oxygen, most of those strains there are strict anaerobes, which means that they actually not only do they not like oxygen, they can't even survive in the presence of oxygen. And so, these next generation probiotics that are going to come out are all going to have this different a feature, which is that they're used to living in an environment with no oxygen. And so, if you want to be able to manufacture them, take them outside the body and really grow them up and deliver them back to people, you have to figure out how to recapitulate that environment where there's no oxygen. And so that's one of the new discoveries, I think, that's going to differentiate the current probiotics on the shelves from the next generation of probiotics. They can't have any oxygen when they're being grown. 


Cynthia Thurlow: [00:12:35] And it's interesting, during the course of preparation for our discussion, there's one specific anaerobic organism that I knew a little bit about, and I say this openly, I knew a little bit about it, but understanding how challenging it can be to create probiotics or to create these organisms outside of our body and do it in a way with integrity, because it is so challenging to grow anaerobic organisms outside of our bodies. It really is incredibly challenging. And so perhaps explaining the degree to which you and your colleagues have gone to to be able to create Akkermansia as an example, to be able to create that outside the body and have it be a high potency product that actually is effective and efficacious. 


Dr. Colleen Cutcliffe: [00:13:25] Absolutely. And hopefully we'll dig a little bit into Akkermansia muciniphila, the most important strain you've never heard of. And really that is the challenge. Like I said, probiotics and yogurts have been on the shelves for decades. When we first started this company, we said, “Okay, well we'll need R&D for innovation.” And then we'll just outsource. Once we know which strains we want to grow, we'll just outsource to these manufacturing companies to make the strains for us. And when we did that, I mean, and we went all around the globe looking for manufacturers, everybody sent us back dead strains. Because all of the manufacturing out there right now doesn't have this, okay, no oxygen can enter the system kind of a requirement. And so, they were growing them in their normal ways of growing them and all these guys were dying. 


And so, what we ended up realizing is that if we really want to get this company kicked off and we're an early-stage startup, every day matters. And so, we had to figure out how to manufacture them ourselves. And so, we ended up having to build our own manufacturing plant and an entirely new innovative system for how to grow these microbes where you are trying to mimic their environment and remember they're not only needs to be oxygen free, but these guys are used to being in an ecosystem with a bunch of other things. And so, it's like when you have a garden or taking something out of a rainforest and you're saying, now I want it to grow by itself in my kitchen. That is a whole new set of environmental factors that you have to take into consideration. 


[00:14:50] So, we ended up building our own manufacturing plant. And even just keeping these things alive through manufacturing is really important. But on the other side of that, the most important thing is that you can deliver these to people. They have to get back to that distal colon, they have to revitalize and they have to perform activities that you want them to perform. So, you're taking something out of a system, you're growing it in this artificial system, you're putting it back in and you're saying, “Do what you normally do.” 


[00:15:15] And so, I think every one of those steps we didn't realize was going to be a challenge, but every one of them, you have to do perfectly if you actually want to be able to deliver people these microbes that give them back these functions. And so, it ended up being almost eight years of R&D work that were not anticipating. [laughs] 


Cynthia Thurlow: [00:15:32] That's really an incredible process. And I think for a lot of people, they just assume that when they purchase, let's say a probiotic off the shelf, that everything in there is still alive and beneficial and helping people navigate making good choices, whether it's probiotic rich food is an example. But I would really love to talk about something that I think is poorly understood. I mean, there are polarizing, dogmatic people on social media that will say fiber isn't important or you can get by without fiber. And I think both of us would agree that there's some degree of bio-individuality. But let's talk a little bit about what fiber, what is its role in the body, why is it important? And how can we, I guess, capitalize on ensuring we are not only consuming the right types of foods that can facilitate the feeding the strains of bacteria in our body that are necessary to be able to have a healthy gut microbiome. And what are the things we need to be looking out for? 


Dr. Colleen Cutcliffe: [00:16:33] Sure. Well, I think it all starts in our caveman, cavewoman days, which is, to remember that these microbes have coevolved with us over time. And so, in those days it was fruits and vegetables, berries and vegetables that, we had the most access to. And so, the vast majority of microbes that are beneficial for our health that we've coevolved with, that's their food, that's what they rely on. They're not used to seeing processed foods and fake sugars and all of these things that we've created in the last decade or last two decades. But that's not the timeline of evolution for these microbes. 


[00:17:07] And so these fibers, these high-fiber foods, are really important because they are feeding these strains that then metabolize that fiber and convert them into things that are actually integrated with our own signaling system. And in fact, there are certain fibers that our bodies we actually can't metabolize on our own. So, we entirely rely on having these microbes to do that metabolism. And some of the important things that get produced on the other side of this metabolism are things that help us, these are called postbiotics, but things that really help us in our signaling of our gut lining. So, butyrate is a really important small molecule. We know that it's really important for colonic health. And actually, there have been a lot of studies around its role to help prevent colon cancer. 


[00:17:48] We know that these short chain fatty acids that get produced by the microbiome are really important for our gut lining. And we can get a little bit more into that and what it means to have a healthy gut lining and how you know when you don't have one. But then probably something that people have started to really learn about lately is that your gut microbiome also produces these things that stimulate your body's natural ability to produce GLP-1. And GLP-1 is a little bit of a hot topic now, although we've known about this small molecule for a long time, we haven't really known all of its benefits. But one of the things that people don't necessarily know is that GLP-1 is actually produced at your gut microbiome. 


[00:18:24] And so, if you don't have these gut microbes, your body is not producing GLP-1 and you're getting all these downstream problems of heightened food cravings, you're not getting good metabolism of sugars in your body. And so, it turns out that, the fibers that you eat are all super important for feeding these microbes that then help you with your metabolism, help you with your gut lining, which helps with your inflammation, your immune response, even your gut-brain connection. So, all of these other systems are dependent on you feeding those microbes. 


[00:18:52] And I'll just say this, which is that I think a lot of the reasons why people start to try to shy away from fibers or try to look for other things is that their bodies are sensitive to this because one of the things that we've done also to ourselves is we don't eat as many fibers as we probably should be eating, most of us don't. Because you're not feeding those microbes, they now don't exist in your microbiome. So, now the fiber that you're eating, there's nobody in there to metabolize those. And so, then you end up getting GI distress or you feel like you're really sensitive to fibers. And the fact is that you then end up in this really bad negative loop where then you think, “Okay, I shouldn't eat fibers.” 


[00:19:27] So, then you're really not feeding those strains, and they just continue to get more and more depleted. And there's a step in way to start to get access to these strains so that you can start consuming fibers ,so that you can really feed these microbes and feed all these other systems. And so, I'll just give that in terms of why people may be shy away from fibers, but that they really are helpful for these microbes. 


Cynthia Thurlow: [00:19:49] And I think that's such an important point. And I like to use myself as the example because it makes it a little more tangible. When I had six weeks of antibiotics and antifungals, you better believe for at least 18 months, I couldn't eat. I loved vegetables. Couldn't eat vegetables. Was full carnivore for nine months. And I used to tell my functional medicine doc, “I know that the reason why I cannot tolerate this is, my entire gut microbiome was obliterated appropriately given my circumstances.” But I think many people will say, well, I have to be carnivore for the rest of my life because I get bloated, I have digestive distress, I don't feel good when I eat vegetables, fruit, etc. 


[00:20:30] And I think it really speaks to the fact that there's something going on that is making it harder for you tolerate these things. But it's a sign that something is off. And to your point, you're talking about, how many things are impacted by an unhealthy gut microbiome. And from your perspective, what have been some of the signs or clues or complaints or concerns people will express when they are struggling with their gut microbiome not being fully optimized? 


Dr. Colleen Cutcliffe: [00:20:58] Well, it's interesting because I think we often think about our gut microbiome as playing a role in our GI health. And so, one of the most common things where you know your microbiome has been disrupted are these GI symptoms. So, things like get diarrhea the time, or I'm constipated all the time, or “I have a lot of gas, or I feel bloated, my belly feels distended all of the time.” And so, there's all these GI symptoms that are signals to you that your gut microbiome might be not optimal. But there's other things too, that we don't necessarily connect to the microbiome. So, we know that there's this gut metabolism axis. Your microbes are metabolizing your food. They are a really important part of a healthy metabolism. 


[00:21:38] And so you might find that Gee I started to gain weight more easily than I used to, or I had these food cravings that I didn't used to have before, or maybe my food cravings are escalating and just getting worse over time. And then even we know that there's this really important gut-brain connection. Your gut actually produces massive amounts of serotonin, GABA, dopamine, and these all go directly to the brain. There's this vagus nerve that literally connects to your gut to your brain. And so, as you start to feel things like, Gee, I feel more tired, I have brain fog, I have this post lunch slump and it seems to be getting worse. These are all things that are also kind of indicators that your gut microbiome might be not optimal.


Cynthia Thurlow: [00:22:21] Yeah. And I think these are important because I think for many individuals, they may have chronic digestive issues, that they're like, “Oh, I have a sensitive stomach” and it could be much larger than that. Or I'm middle aged, I'm not getting good sleep. This is why I have brain fog or “I'm going through perimenopause and menopause. This is why I'm having these symptoms.” And it can be so much larger than that. What are your thoughts on- Because I had some questions that came in around greens powders, polyphenol powders. Are you a fan of these products? Do you think that they're helpful if someone is struggling to get enough? And I'm not saying brands, I'm just going to say greens powders, polyphenol powders. 


[00:22:59] Do you think that they can be helpful if someone is working diligently on gut health? or do you think it's more important that we're actually consuming the food, chewing it up, swallowing it and going through the whole digestive process as opposed to a powder that's mixed in liquids? 


Dr. Colleen Cutcliffe: [00:23:15] Sure. Well, I think the goal is to get as many fibers into your system as you can. And of course, as we've talked about, the natural way for your body to get those is actually through the whole foods. So that produce section of the grocery store where you got your fruits and your vegetables, that's the best way. Now, not everybody can prep those foods in a way that is enjoyable to them. And not everybody has time to do that. And so, there are a lot of reasons why that might be really hard to do. So, in that case, rather than just throwing our hands up, there are these supplements and these green powders and a variety of actually these different mixes that you can mix with your water. 


[00:23:52] I mean, Metamucil is probably, we're not going to name brands, but that's the oldest version of this. And now people have started to add other things into those mixes. But all of those are beneficial for getting those prebiotics, those fiber parts into your body and help you boost those microbes. And there have been studies showing that supplementing things like inulin and supplementing polyphenols can have a beneficial impact to your microbiome and feeding those bugs. So, I would say that whatever tools you need in your toolbox to get those fiber components in is great. Starting with the fruits and vegetables straight from the grocery store and then going to those powders, if that's easier for you to get them in. All of that is better than doing nothing. 


[music]


Dr. Elisa Song: [00:24:37] So, I will tell you one gap in our health and wellness literature outreach is our teenagers. Our preteens, and our teens, and our young adults, sort of as moms, we have this, we're reading all the books. [laughs] We're the parenting books, the wellness book. But then all of a sudden, they hit this prepuberty and puberty stage and we're like, “Okay, now what?” [laughs] Because it's not just about us anymore. It's really and truly about them, which we want to take that opportunity to empower them and I will tell you this book, I had one mom whose son is either a junior or senior this year, and he's an athlete. He's a football player. He read parts of the book with her and started making different choices. He started changing what he chose? 


[00:25:21] He went out with his friends, hung out after football practice and games, but he chose differently. Instead of getting, the mocha chip, whatever, Frappuccino with the 52 g of added sugar, he thought about it, and maybe he did choose that sometimes, but at least he knew what he was choosing and how we could make different choices around that. And so that's what I want. [laughs]. I mean, my high schoolers in the practice who are going off to college now, and they're asking me really astute questions, when they're looking at a supplement like, I have a kid who, I mean, gaming it's a thing and so, what's fascinating is the gaming supplement industry is exploding. 


[00:26:01] These nootropics for these gamers, how do you get your brain on? And so, I mean, thankfully, this kid who's 14, 15, asked me about the supplement he saw, obviously, targeted marketing. And it's this neon green, powdery, has sucralose, has acid sulfate, potassium, and yet the other ingredients, it has carnitine, it has phosphatidylcholine, it has CoQ10. I mean, it has a lot of the supplements that I would recommend for nootropic support, neurologic support for a kid. So, I said, “Look, I'm all for reaching your goals. Let's take a look at these ingredients and understand what this acid sulfate, potassium and these sucralose, these artificial sweeteners, do to your brain and to your microbiome. And let's see if we can find some other solutions.” 


[00:26:42] So, I love that and I think when you frame for kids, little toddlers, all the way up to teenagers, even for adults, when you frame how our choices affect our microbiome and how important our microbiome is for our brains, immune systems, hormones, etc., even our epigenetic potentials, it makes it a little easier. It's just like for moms, it's so much easier for us to make those choices when we know it's going to help our kids, if we know our choices are going to affect this whole ecosystem inside us that actually is helping to support us. It does frame it a little differently. I do think it helps. So, you mentioned the butterfly effect, there was a I believe from MIT, Dr. Lorenz, a meteorologist who coined this butterfly effect. 


[00:27:26] And I actually don't know if he coined it or if it just came afterwards, but he made this comment. He was doing all these statistical analyses about these tiny shifts that could happen in the atmosphere, in the environment and is credited with saying a comment something to the effect of, if a butterfly flaps its wings in Austin, Texas, could that set off a tornado in Taiwan? And so, the calculations showed, yeah, it actually could, right, this tiny little change. And that's the same thing with our microbiome. A tiny little shift, for worse or for better, can set in motion this ripple effect for positive lasting benefits on your HPA, your hypothalamus, pituitary adrenal stress response, your hormones, as you're developing through puberty and your thyroid, you're developing immune system. 


[00:28:13] And really, I think for us as parents, so importantly our children's developing brains in the toddler years and also in these preteen, teen years because there's this explosion of change in our gut microbiota, the diversity and function, composition that occurs in our toddler years that drives the changes in our toddler’s brains, our baby’s brains. But the same thing is happening in our preteen teenage brains. So, we had the additional opportunity and so understanding that foundation and understanding and a lot of people want to know the science, they want to know maybe they're on board, but partner isn't on board or their kids aren't. So, I give a lot of the research on how the microbiome truly for children and teenagers whose brains and immune systems are continuing to develop, how that shift can occur again for better or for worse. And we get to choose, we get to choose a lot of it and what direction we want to take. 


Cynthia Thurlow: [00:29:07] And I think it's so interesting because certainly when we train, there was no discussion about the gut microbiome. And yet in the last 5 to 10 years there's been an explosion of research and focus on this. And it makes so much sense that things we put into our bodies have a huge net impact on the health of our gut microbiome. And fully understanding that it has far reaching implications, far more than I think the average person understands. And I think I would be remiss if we didn't discuss a very big topic which is antibiotics. You and I both know that sometimes they're used judiciously, sometimes they are not. 


[00:29:44] I think for many parents when you're in the stage where you can't leave your kids at home if they're sick and you're working and how stressful that can be, I know that colleagues of mine that were pediatricians would sometimes say they felt pressured to prescribe when it was probably something viral. But let's talk about how antibiotics impact the gut microbiome quite significantly. 


Dr. Elisa Song: [00:30:07] So, this is such an important issue on so many levels, on a global public health level and also on that individual patient level and so important that there's actually an entire chapter, it's Chapter 10 in my book. [laughs] It's called What Every Parent and Practitioner Should Know about Antibiotics. Because on a global public health level, we are at the point where antibiotic resistance could become a leading cause of death by 2050. That's right around the corner. And that could be so frightening from really acknowledging that antibiotics are one of the greatest public health inventions of the 20th century. And now we're in the 21st century where we may not have antibiotics that could treat a simple ear infection or a strep throat. 


[00:30:57] I mean, we should all be raising the alarm, not just practitioners and public health ,people, all of us. And then as you said, there in some studies, up to 70% of antibiotics prescribed for children are inappropriately prescribed for things like viral infections or maybe they're a little broader spectrum, a little stronger than they need to be. And one thing that you said, that in some cases it's not necessarily the pediatrician just writing the prescriptions, although I will say straight out of residency, I was moonlighting in an urgent care, and I was seeing literally one patient every five minutes, eight minutes. It was crazy. I didn't have time to pee because every time I went to the bathroom or even get a sip of water, I'd see 10 more charts stack up. 


[00:31:42] So, I'm like, I just plow through. And it's all you could do to just get your head above water. And in that situation, if a kid comes in with an earache and you really want to talk to them about waiting and watching for 72 hours and hear the signs and if you have an integrated pediatrician, here are some options for using things garlic oil that has as evidence to back it up. You don't have time. And so, there's that. And then get this. In one study, they found that physicians are maybe up to twice as likely to prescribe antibiotic prescription if they think the patient wants one. 


[00:32:21] And so, simply by you as a parent or a child saying, I want to discuss this, I'm not the one who wants just to walk out with a script, because there are some parents like that. I am the parent or the child who I want to know. I want to ask, are there options? What are the side effects? How do I mitigate the side effects? And then as an individual, when we understand the impact of antibiotics on our microbiome, it does make it easier to feel confident asking those questions, because just a couple of studies that I'm going to pause and just say, as a mom, if you go back and think, “Oh, my gosh, this was my child, this happened,” we can't undo the past. 


[00:32:55] And I know there's plenty of mama guilt that will always be around, [laughs] no matter how old your kids are, it's going to come back. But it's really important to just know this. We need to know the story of how your child or teenager or young adult child got to where they are. But one study that looked at over 800,000-- or almost 800,000 children and followed them from birth to about four years of age, found that antibiotics or even antacid medications to major microbiome-disrupting medications given in the first six months of life could significantly increase the risk, maybe even double the risk of virtually every single allergic disease, including eczema, asthma, hay fever, hives, and anaphylactic food allergies, which, when I was training in residency, I mean, hardly a patient who needed an EpiPen, and now there are shortages.


[00:33:50] And this even includes, unfortunately in-utero exposure. So, sometimes parents will say, “Well, they didn't have antibiotics.” But you received antibiotics while you were pregnant for UTI or a sinus infection, or just like with my son, Bode, I was group B strep positive. So, I received antibiotics around the delivery. So that does impact. And so, we need to know that and educate OB/GYNs and pediatricians and parents moving forward. 


[00:34:18] Another study in Denmark, keeps these amazing databases for research, found that they looked at mother-infant pairs and followed these children and found that antibiotics, even in-utero, at any point in this child's life, could increase the risk of virtually any mental health concern by up to 50% when they were older kids or teenagers. We know that by the time in the US kids are 18, 1 in 2 is going to have a mental health diagnosis. I mean, that's like every other kid in your kid's high school class, right? 


[00:34:55] And the highest risk when those antibiotics were received before six months of age, showing you the priming effect, that foundational effect. But the higher-- the more rounds of antibiotics, the greater the risk as well. We see this in adult studies too. It's in the literature. So, like you said before, there is a time for medication. We are firmly grounded in our conventional medicine training. We need that. And yet now, from an integrative, functional medicine standpoint, we need to understand, look, antibiotics are there for a reason. Now, we know all of these unintended consequences on their microbiomes. How do we get the benefits from the antibiotics and know how to mop up and restore the microbiome disruption that will occur not just after antibiotics, but after a whole host of other medications. 


[00:35:42] So, that is where, we can really have an integrative approach, not throw the baby out with the bathwater. Now, on the other hand, part four of my book, I use homeopathy essential oils. I have one right here to perk me up, [laughs] acupressure points, herbal medicines. So that instead of the waiting and watching supportive care approach that we have in conventional pediatrics, which basically means there's not much you can do, of course, hug and cuddle your kid, give them fluids and just wait it out. There are so many natural remedies that can help your kids actually get better faster and potentially help you avoid the need for antibiotics or know that if antibiotics are needed, they really were needed. 


Cynthia Thurlow: [00:36:25] So, let's say that someone appropriately has prescribed antibiotic therapy, what are some of the things that you work into your treatment protocols with your patients that are helpful for restoring that gut microbiome? Because I think everyone's probably listening, how many times has my kid been prescribed antibiotics? What are the things I need to do proactively? So, what are some of the things that we need to be thinking about as parents? 


Dr. Elisa Song: [00:36:50] Well, and as we can't go back in time, I really want everyone to understand, from an integrated pediatric standpoint, even for my own children, when Kenzie was two to three weeks of age, she did get antibiotics for a urinary tract infection. We don't mess with infections. When babies are under one month of age, even up to maybe under three months of age, there's not a lot of wiggle room. I mean, infections can get serious pretty quickly. And my son between four and five weeks of age, there was strep going around, this family wedding that we had been to, and of course he didn't get strep throat. It's interesting. Little kids don't tend to get strep throat. They get it elsewhere. 


[00:37:34] But all of a sudden, he had this. I mean, it's kind of gross, this green drainage from his ear, like, “What the heck is going on?” At first, I thought, “Oh, it's nothing.” But then my sister's like, “It's coming back.” So, we took him to urgent care, and I asked my friend who was working there. I'm like, “Can you just send a culture?” Because I didn't want to be my own baby's pediatrician. And it grew out group A strep. I've never seen it before. I'm like, “Okay, my kids are here to teach me.” So, both my kids had antibiotics. And so, I did, at that point, fortunately, understand the impact of the gut microbiome and how this could influence their future health. 


[00:38:10] But even if you didn't, even if you're listening now, and your kids have had four or five different antibiotics or let's say they're on other medications currently, as a teenager that we know disrupt the gut microbiome sometimes, in some studies as much as antibiotics, like, well, of course, many teens are on doxycycline for their acne, a low dose. Low dose doesn't matter. It still disrupts the microbiome. They are on a birth control pill, which also disrupts the gut microbiome because they have horrible period cramps and they have a lot of anxiety. So, they're on an SSRI like Lexapro, that also disrupts the gut microbiome. So, they're on these medications that may be absolutely needed and helping them in the moment. 


[00:38:51] But over time, what I see in my teenagers who are on these meds, they stop working as well. And so, the SSRI, it stopped working. And now what? now we go on to the next medication and the birth control pill, which disrupts the microbiome and also depletes your B vitamins, can be contributing to the worsening anxiety and of course, the antibiotic. It's about telling your child's story. It's about unraveling the pieces to see, “Oh, wow, I didn't realize all of that could be impacting what's going on.” But when we know, we can say, “Look, these medications, she's doing well on them, or he's doing well on them, or he's doing okay on them,” but we're not going to take them off right now. How do we keep their microbiome resilient? Or if it's been in the past, how do we restore it?


[00:39:35] And we can do that at any stage. So, even if it's been 10 years, since their antibiotics when you were pregnant, or delivering, we can still. The longer it's been, it does get a little bit harder to shift things. It's just like adults, as adults, if they've been working with you on some of their dysbiosis issues, we know it can take a while or if you have Candida, oh, yeah, it's gone for two months and then it comes back. [laughs] But the younger you start and your kids are like this open book, So, the foundations, it's not just about throwing a hundred gazillion colonies of probiotics into your gut. 


[00:40:14] That is actually one of the biggest shifts that I have made over the past maybe, five years in my thinking about probiotics and the research around restoring your microbiome. Because we often think, of course in America, more is better. And so, we get these mega doses. And it's really not about the mega doses. In fact, sometimes mega doses might crowd out and prevent your native beneficial flora from coming back. And I tell kids, look, it is not like Jack's magic bean socks. You can't just throw them on the ground, walk away and [Cynthia laughs] expect this amazing magic bean sock to grow. They need an ecosystem to call their home. 


[00:40:56] They need a neighborhood that they want to say, “Hey, I'd like to move in there and I want to bring all my good neighbors with me and stay.” It's really about that. And so how do we do that? I mean, I talk about the five things for creating microbiome magic, but that is one of the things I'm going to say they're all important. The two most important things I think that we can teach our kids is how do we think about nourishing our microbiome to nourish ourselves. And what foods do we want to get in? One of the things that we want to be savvy about keeping out to the extent possible. 


[00:41:29] And then the second thing is how do we on a daily basis engage our vagus nerve to regulate our nervous system? Because that foundation of the gut-brain connection via the vagus nerve will set your kids up and set their microbiomes up for success, no matter what life throws their way. 


Cynthia Thurlow: [00:41:51] I think it's so important because I'm sure many people listening have heard the nutrition piece. There is clearly some foods that will disrupt the health of our gut microbiome. There are others that will beneficial. The vagus nerve may not be as familiarized with my community. And I'll just share the story that when I first met you five years ago, you were talking about heart math and you were talking about heart rate variability, and you were talking about the vagus nerve and it left a really indelible impression on me. So, for the benefit of listeners who may perhaps not be as familiarized with the role of the vagus nerve and why that's so important, let's spend a couple minutes talking about this because this applies to adults as well. 


[00:42:34] This is something that working in clinical cardiology, I can't tell you how many people had a dysregulated vagus nerve or they had a vagotomy. Sometimes, the nerve is cut and the net impact on the body is quite significant and profound. But let's talk a little bit about the vagus nerve and heart rate variability because they're both very, very important to understand.


Dr. Elisa Song: [00:42:55] This is really and truly, the microbiome and the vagus nerve are my two favorite topics to talk about because they're so important. And the research, as you said, on the microbiome has really been exploding in the last five years, even the research around the vagus nerve. And many in your audience listening right now, you've probably heard of the vagus nerve because it's having its day. But we have to understand it because it's not just about wearing the devices and the gimmicks that will improve your heart rate variability. Those can help. I wear one just to help support me. Because I mean, every day we have forces that are really impacting our vagus nerve's ability to kick in. 


[00:43:36] But it is about the work that we can do to engage our vagus nerve every day. So, just to back up, we have a part of our nervous system, it's called the autonomic nervous system, that's involuntary. There's a sympathetic arm to our autonomic nervous system. So, the sympathetic nervous system, as many know, it's responsible for our fight or flight. Pupils dilated, we get a little sweaty where our muscles contract, we start breathing more shallowly and we're getting ready for something. I mean, we've all heard of the proverbial saber-toothed tiger only now in our modern world, kids and adults, we have a saber-tooth tiger attacking us almost every moment of the day. We're late for school. We have a soccer tournament. 


[00:44:17] I have to give a speech in front of class. My friend just texted me something awful and I just saw this horrible social media post. I mean, all these are like, “We're late for work, or I have to pack the kid’s lunch, I have to do the this and then that.” So, every moment we're like our sympathetic nervous systems and many of us it's our sympathetic nervous system is just on all the time and we don't even realize it. If you round a corner and your kids suddenly pop in front of you and you're like” Huh,” if you really jump and you're not just like, “Oh, hey, Kenzie,” you're activated, [laughs] And so, our sympathetic nervous system gets a ton of exercise every day. 


[00:44:58] When in our normal healthy state, we want our sympathetic nervous system to kick in appropriately. Just like as your listeners know inflammation is not a blanket bad thing. It's when it's persistent and chronic that it is. Stress is not a blanket negative thing. We need stress to fight infections to get motivated. But it's just that it's up here, chronic and persistent. And normally what happens when we have a stressor. I'm stuck in traffic, I'm late for work, then you get to work and you're not late. Your parasympathetic nervous system and your vagus nerve kick in and say, “You know what, you're okay, let's get back to the rest, digest and heal, calm state.”


[00:45:39] Well, this parasympathetic vagus nerve response it's like down here all the time. It's not getting any exercise because we're not engaging it purposefully. And we need to start doing that. We can assess now your vagus nerve functioning in a variety of ways. And a lot of people may wear an Oura Ring or your Apple watch can do the same thing. And heart rate variability is what it sounds like. So, I'll have even kids or parents in the office, I'll have them find their pulse on their neck and just notice when I'm explaining what heart rate variability is, you notice what the rate is. And now you take, let's say it's kind of like this and you take a slow breath in and then you exhale slowly-- Oh, wait, sorry, let's do that backwards. You take a slow breath in and then you exhale slowly. 


[00:46:30] So you're, your heart rate is variable depending on whether you're breathing in or breathing out. It should speed up when you're breathing in. It should slow down when you're breathing out. That is normal, appropriate heart rate variability. When we're stressed, it's just boom, boom, boom, boom, boom, boom, boom, fast and constant. And what's fascinating is there's a cardiologist in Germany who I'll send you the paper. I think you would love it. Cynthia. It just floored me because we know our microbiomes have historically changed over the past century, from the time when we could measure our microbiome. But even since the 80s, this cardiologist in Germany has been monitoring kids heart rate variabilities, mostly because he has kids with ADHD, they come in for the EKG and so he's been monitoring. And so, he has historical controls of kids without ADHD and with ADHD. 


[00:47:18] And he's found that over the decades, their heart rate variability is significantly lower, which I am going to guess is absolutely true for adults. And why heart rate variability? Heart rate variability is one of the best predictors of current and future health. The best predictors. And when it comes to our microbiome, why is engaging our vagus nerve and improving heart rate variability so important? Because there's one study in children where improving heart rate variability with things like gratitude or walking in nature, hugging, gargling, singing, all the things that we can do that actually are free to engage your vagus nerve, improving heart rate variability was found to improve their microbial-- microbiome functioning and diversity, independent of diet. 


[00:48:09] And so if your kids are really selective, or maybe they're going out with their friends and you're just cringing at what they're eating when they're out with their friends, if we help them engage their vagus nerve every day, that's helping their microbiome. It's so key. And this intimate gut-brain connection, this information superhighway that is from the microbiome to your brain. 80 to 90% of that communication occurs from your microbiome to your brain via this vagus nerve. So, whichever way you're going, you still need to engage the vagus nerve. And when you engage the vagus nerve, you're going to help your microbiome and you're going to help your brain. 


[music]


Cynthia Thurlow: [00:48:49] Definitely a fan favorite on the Everyday Wellness community. I would love to talk about the interrelationship between the health of our microbiome and body fat as it relates to metabolism. I know that for many individuals, and especially, for those of us that trained in the 1990s, early 2000s, the microbiome has really exploded it in terms of how influential it is on our bodies and systemically. But I thought it would be interesting to weave this connection together, maybe helping to reinforce why nutrition is so important vis-a-vis the microbiome and our metabolism. 


Dr. William Li: [00:49:27] Great gateway to walk through to talk about a lot of exciting things. Look, microbiome is now, I wouldn't even say the buzzword. It's part of the vocabulary of health. And it's a good thing too, because as a scientist and as a physician, I think that it's really important and exciting to see when new discoveries become part of the mainstream of thinking and of conversation. And it's really from that point of view, I want to just give a couple of examples of how important the gut microbiome is. So, for example, in 2017, I helped to organize a conference in Paris about cancer. And we wanted to bring together, it was called Beyond Cancer, Beyond Drugs or something. 


[00:50:08] It was a cancer meeting in which we didn't allow you to talk about chemo and didn't allow you to talk about newfangled therapies. And so, when you remove all that from a credible cancer conference, what do you got? You got mental health, you've got diet, you've got exercise, all the things that are important to patients. Well, enter the microbiome. And there was at the time a research study that was about to be published the next week. And so was under embargo. And embargo just means like under wraps, it was kind of a secret, but were able to share that information. And the most stunning thing that I learned that day was the importance of your healthy gut and whether you're going to respond to cancer treatment or die. 


[00:50:52] And to me as a researcher, it like stunned me that the difference in 200 people who are getting state of the art cancer treatments of different cancer types, that whether they actually made it or didn't make it, whether they responded to treatment or whether they didn't respond to treatment, relied on in that research study, one bacteria which everybody now talks about called Akkermansia. And this was published in the journal science, which is one of the most credible journals out there, came out a week later and I literally said, “OMG, this is like proof of principle, how important gut health is.” 


[00:51:22] I don't really care if you've got irritable bowel, if you've got all these other things with gut health and you want better body shape, body composition, but when it comes down to the black and white of cancer, which affects everyone, including myself, my mom had cancer, my two uncles died of cancer. The reality is that like you pay riveting attention to it. Now fast forward to just a couple of months ago, another study came out that again opened my mind yet again to the importance of the gut microbiome. And I hope I'm getting people's attention talking about this as just the intro to dive into gut microbiome and metabolism. But here's a recent study that looked at a bacteria that called PS128, it's a Lactobacillus, and it was studied in Parkinson's disease. 


[00:52:05] Now, we don't really have good treatments for Parkinson's disease. And the treatment we do have actually either don't work very well or they have side effects, some bad ones, some serious ones. And everyone knows the work of Michael J. Fox and the tremendous effort that's been gone-- that's been invested to find better treatments. Well, enter the gut microbiome. This one bacteria which can come in as a probiotic, PS128, seems to be able to lower the symptoms of Parkinson's disease as an intervention. And I looked at it again, published in a real journal, like a serious journal to go, wow, this is like confirmation that our health of our gut makes a huge difference in terms of our health.


[00:52:47] So, if I haven't gotten their attention yet, I'm talking about the gut microbiome, healthy bacteria, I'm talking about life or death with cancer and I'm talking about a neurodegenerative treatment disease that up until now we didn't think there was really much of a path forward and addressing our gut health makes a difference. And so, this is actually the reason why I'm passionate to talk about this subject with you as to get into the material. 


Cynthia Thurlow: [00:53:11] And I think it's so important for people to understand. I think the microbiome seems intangible, especially for individuals maybe that are not clinicians or researchers. But I think for a lot of individuals, the concept of the gut microbiome is so intangible. So having those concrete research examples, can help many people understand that although they cannot see it, that it is something that's incredibly important. And I want to jump back and talk specifically about Akkermansia. I just interviewed Dr. Colleen Cutcliffe and this is kind of her area of expertise is the Akkermansia and the gut microbiome. And what I found really interesting about this keystone bacteria is that it is not just important for the mucin lining, so the lining of that small intestine, but it's also implicated in things like our endogenous production of GLP-1. 


[00:53:59] So, I think a lot of people are familiarized with GLP-1 agonists, semaglutide, Wegovy, they're very popular right now. But understanding that by supporting particular keystone bacteria, we can also then support these bacteria and have them work more effectively. Have you found that there are specific foods that are tied to supporting the microbiome in much more profound and beneficial ways than others? I would imagine things like fermented foods, etc., would be of benefit. Polyphenol rich foods. 


Dr. William Li: [00:54:31] I'm going to talk about that exactly. But I want to bring one more piece of articulation to the microbiome for people that are still having a little trouble getting their arms around it. Let me tell you how to measure the microbiome. Let me tell you how to measure your microbiome or mine. Basically, you get sent a kit. Your doctor can give you a kit or you can mail away for kit. And it comes with a clear tube with a screw top on it, okay. In the lab we see these tubes all the time. And there's a cotton applicator, like a COVID test thing that you don't put it up your nose. Please do not put this up your nose because you're going to put it on toilet paper, it's got some of your poop on it, and you just twirl it around and you and takes you five seconds. And then once you actually have a bit of that poop on there, you stick it in the tube, screw it shut. Now no germs are going to go in or come out and you stick it in an envelope and it gets mailed away to a lab. And the lab, just like after you actually get your blood drawn, the nurse will come up and the phlebotomist and draw your blood and you see it in a tube, the same deal, goes away. And just like we can't see our blood cells, we see just the tube of the blood going away. 


[00:55:32] So too is the gut microbiome. You send it away and you let these people with very sophisticated equipment crunch down to look for what kinds of bacteria are there, how many are they there, how similar are they? and are there any good guys there or bad guys there in the gut? And that's really how it's done, takes about two to three weeks to get a result. And then it comes up on your patient portal just like everything else. And so, for anybody who's really just had this question mark cloud over their head, like, “You know, I hear this all the time. I don't have an idea about what it's like.” I'm bringing it right down to earth because this is exactly how it's done. 


Cynthia Thurlow: [00:56:09] Do you have a particular company that you recommend or use or one that you have a preference for? 


Dr. William Li: [00:56:14] First of all, I don't get paid tell you this. I'm somebody that just likes to share what I do. I think there are many different companies that are out there. I'm not promoting any one, but I'll tell you the one that I've worked with because I trust with the technology that they use and the rigor that they do and look like you I'm a healthcare provider and we operate with a certain level of standard that we're expecting. And so, when you meet, find somebody that, or a group or a lab that meets that standard, you feel comfortable with it. And when you're not sure about the quality, we tend to be cautious about using them. 


[00:56:50] So, I use a group called Sun Genomics out of San Diego and they have done really a fantastic job. I'm sure there are others as well, but for me, that's been really my go to. Now let's talk about foods that actually help the microbiome because the measuring your microbiome is the first step to knowing what you need to do. Just like the blood test. “Doctor or nurse, I'm feeling a little weak let's draw some blood, let's see are you anemic? Is your blood count low?” If so, what can we do with nutrition? What do we do? We need to give you a blood transfusion to tank you up. This is part of the modern vocabulary with the microbiome, is we have to measure first to know where we are and then we can actually make a decision about it. 


[00:57:27] So, one thing I would actually just communicate about first. So, we're talking about the measurements first and the diseases as well, is before you just jump around and start buying probiotics because this is where people get confused. I would say if you have a serious interest in your own gut health, go ahead and get it measured. Check it out, ask your doctor, a gastroenterologist should be able to do it or do research online and find a place that is well reviewed and credible. As I mentioned, I use Sun Genomics, but there are many others. And get it measured. Know where you stand, all right that's the first thing. If you're going to sell, figure out what you need to do to sell your house, get it appraised. Take a look at what you need to do before you actually invest any money. 


[00:58:06] And that's my recommendation. In order to be able to address problems and then also to know where you're good, because you're probably going to be good in some areas. Get credit for the things you've already done before you start reaching for the stars. Now having said that, let's talk about food. Because the things that we can do every single day with or without a microbiome test. I appreciate when people are biohackers and they want to know everything about themselves, but many people, myself included, like, I don't need to know what's happening every second. But I do want to do things that are good for me on a regular basis. And this is where food comes in. 


[00:58:41] So, if you want good gut health and good metabolism, with good gut health, you want to eat foods that are either giving you healthy bacteria and you get fermented foods. So, what are some fermented foods that you can get in any grocery store these days, Yogurt? okay. And I want to come back to yogurt in a second. You can get kefir, which is a fermented dairy product. You can get the sauerkraut, which is fermented. You can get kimchi in a lot of places now, they'll have jars of kimchi. You can certainly go to an Asian market to get kimchi. Those are all really, really good for because they contain natural bacteria. Now, I know this might sound a little controversial, but because I talked about yogurt, which is a dairy product, let me talk about cheese. 


[00:59:23] Because what researchers are finding that is quite surprising is that the epidemiological studies are showing that cheese isn't as heart harmful as we used to think it is. In fact, it's actually pretty good. There have been studies that have shown eating cheese can actually lower the risk of cardiovascular disease. Well, that on the surface didn't make sense until we're now beginning to rethink the fact that most cheeses are fermented dairy products and fermented with bacteria. They are probiotic foods. In fact, we know that Camembert, we know that Parmigiano Reggiano, the Italian stuff, the good stuff, they're fermented with lactobacillus and other types of bacteria. The mold in a cheese that goes in a cheese cave, the blue cheese, the taste, the wonderful taste. If you like cheeses, that's all because it's been fermented. 


[01:00:10] When you eat cheese, you're seeding your own gut with healthy gut bacteria. And amazingly enough, when cheesemakers over thousands of years have figured out how to do this, they figured out how that the good bacteria in using the cheese making process out compete get rid of all the bad bacteria, more good than bad. There's no drug dealers in the neighborhood. There's only good citizens in the neighborhood. And yes, you do want to be careful about eating too much cheese. I'm not endorsing or telling people to eat cheese. I'm just telling you it's another product that's actually got probiotic properties to it. Now that's eating the bacteria. But just like you have a dog or a cat or a bird or goldfish, if you're actually keeping a pet. 


[01:00:48] And think about our healthy gut bacteria as not one pet, but actually, I don't know, 39 trillion pets that are inside our gut, by the way, just also bring it down to reality. People go, “Well, where's it in my guts? Under my stomach? Is it in my esophagus? Where is it?” Most of our healthy gut bacteria lives in our colon. And if you're above 50, you should have had a colonoscopy. And in a colonoscopy, a doctor gives you some relaxation medicine so you don't remember it. And they put in a tube, a colonoscope that goes in through the rectum and snakes up through the colon. It goes up, it goes across your belly, and it comes down to a place where your appendix lives called the cecum. That cecum, which is a soft bag of the colon, is where most of the gut-bacteria live. Your gut microbiome tends to live there. 


[01:01:34] And in fact, I mentioned it's where the appendix is. We are now beginning to believe that the appendix may play a role in air traffic control of our gut bacteria. So, whip out your appendix anymore. And I think in the future, surgeons are not going to be taking them out quite as quickly. So, when you eat good, healthy gut bacteria, that's where it actually sits. The healthy gut bacteria seeds, it fertilizes that garden in our colon, right where that soft part of the colon, the baggy part called the cecum, right where the appendix is, and the bacteria grow there. And that's the good, healthy ecosystem. 


[01:02:07] But like a pet, you got to feed your pet. You have a dog. I mean, come on. If it's dinner time and you haven't given Fido the kibble, you're going to get the barking. They're going to follow you all around, and they're going to start rooting into the pantry. And so, we actually have to feed our healthy gut bacteria, the bacteria, we call them probiotics if you're ingesting them, probiotic foods like sauerkraut, kimchi. Actually, what is the food for the bacteria you got to feed them. Goldfish flakes for the goldfish. Bird seed for the parrot, kibble for the dog, cat food for the cat. For your gut microbiome, we give them prebiotics. Prebiotics are the food for our gut bacteria. Now what are the prebiotics that we want to eat? 


[01:02:49] Well, listen, almost everything you've heard about going to the produce section and eating the rainbow colorful foods, the brassica, the green, the broccoli, the brussels sprouts, the bok choy, the radicchio, the yellow bell pepper, the green bell pepper and the mushrooms and all these other things that you find in the produce section, they all contain natural substances called bio-actives. Yes, they used to be famous because people tagged them as antioxidants. Now we're beginning to have a much more sophisticated view. They do a lot of different things. One of the things, many of these bio-actives, natural chemicals in the foods in the produce section, plant-based foods, they are prebiotics. They feed our gut bacteria. So, when we eat a salad or a bean stew or we create a pesto. When we're eating that stuff, we're of course enjoying the taste and we're absorbing the micronutrients. 


[01:03:40] And of course those bio-actives are good for our health defenses and good for our metabolism. But some of that gets tumbled on down below to your gut and before you poop it out, it feeds on gut bacteria. And that gut bacteria takes their food and they metabolize the food that we ate for ourselves, that they eat and they create from the food that we feed them wonderful healthful metabolites, other natural chemicals called short chain fatty acids. And so that neighborhood of healthy bacteria in our gut, they eat dinner time, lunchtime, they nibble on the stuff, they digest it and then they release these metabolites, short chain fatty acids that get into our bloodstream. We can measure these things. 


[01:04:22] And when they get into our bloodstream, they go to our brain, they go to our heart, they go to our muscles, they go to our body fat, they go to our kidneys. And those short chain fatty acids improve our overall health and mental wellbeing. That gut-brain axis is real. The gut-metabolism axis is real. So, this is actually part of the new teaching that in the future, if you're going to go to medical school, nursing school, nutrition school, this is going to be part of the first-year curriculum because it's the basics. 


Cynthia Thurlow: [01:04:54] It's really so fascinating. You did such a beautiful job making it relevant to listeners. I do have a question, though, and this is something I've been asked with some frequency. It must be the beginning of the year and everyone's getting their colonoscopies. The prep for the colonoscopy induces quite a bit of defecation, diarrhea. Do you have any sense of the impact on the gut microbiome from all of that forced evacuation prior to having the scope? 


Dr. William Li: [01:05:22] Yep, it's been studied. That's what it studied. And it's been studied because we can measure it and that's the key thing. So, right now for people listening or watching, we're two medical professionals that are able to communicate really clearly with each other. And what we're doing on podcast is we're really trying to exchange this information, have a conversation in a way that other people can understand. So, you just ask a question that a doctor or a health provider or nurse should be asking their colleagues in the clinic. when you do a clean out before colonoscopy prep. So, if you haven't had one, if you had one, you know exactly what I'm talking about. [laughs] 


[01:05:57] And if you haven't had one, let me just tell you. When they're actually checking out and making sure you don't have cancer or polyps or whatever, as part of the checkup, after you're 50, you got to get rid of all the stuff that might be in your bowels. So, you drink this big vat of stuff. And what it does is it cleans us out. So, you wind up actually having a bowel clean out. Got a bunch of diarrhea that occurs usually the night before you start drinking it. In the morning, you're clear and you go in there and now at the tube that your gut colon is really easy to look at. You can shine a light around, it's like going caving. There's no bats in a belfry. [Cynthia laughs] It's completely clean. And you can go check out for cancer and ulcers and polyps and stuff like that.


[01:06:38] Now what happens to the gut microbiome? Because indeed, when you have a lot of diarrhea, you're flushing out the gut. And it turns out they've measured after the bowel clean out. You actually do change the gut flora. That's the neighborhood. The makeup changes a little bit. But our healthy gut is so resilient that after a bowel prep, it starts to get back to normal in 24 hours, it starts to rebuild itself. And by the end of a week to 10 days, it's pretty much back to normal. Normal being what it was before you cleaned yourself out, but maybe not as normal as you want to be. 


[01:07:12] And this is the point about eating healthy, because if you actually realize that every time you make a decision to eat something, snack, breakfast, lunch, dinner, you're not deciding for one. You know how pregnant moms say like, “I'm eating for two.” Well, now you're eating actually for 39 trillion plus yourself. And so, we all carry a great responsibility when we make a decision about what we're going to eat to make sure we're also feeding our gut bacteria properly. So, what are some of the things that damage our gut bacteria? Because I know everyone was about to say that, like, “What do I need to stay away from?” Dr. Li, you're telling me maybe it's good for my brain, maybe it's good for my mental health, maybe it's good for my heart, maybe it's good for. Well, like what do I need to avoid?” 


[01:07:52] Let me tell you that eating a lot of added sugar in your foods damages your gut microbiome. We don't know exactly how or why. And many things that have a lot of added sugar also have a lot of other artificial chemicals, preservatives, colorings, flavoring. So maybe it's all also not just the sugar, but the other stuff in these ultra processed foods. So, you want to cut down or cut out your ultra processed foods. You want to optimize your gut health, try to eat whole natural foods that are fresh. 


[01:08:21] Now when I say fresh and I say whole, I don't mean that you have to just eat at the salad bar because as it turns out, when you go to the grocery store, some of the healthiest foods for our gut are actually found in the middle aisle. So, if you actually look for beans, canned beans are also really good. Dried beans are also really good. Whole grain foods, also really good. And by the way, dark chocolate, 80% cacao as well. Also good for the gut microbiome. Coffee, tea, things, you would go into the middle aisle. Those have been shown to actually be beneficial for our gut microbiome. 


[01:08:50] Tree nuts, the bulk nuts you go to in the grocery store and you're seeing these big plastic canisters with a shovel below it and I don't know what the heck I would do with that if I got stuff. Well, listen, here's what you want to do that is gut microbiome food. And so, what I tell people to do is take a little tub, the smaller tub. Don't buy a lot. You don't have to go to the big box stores, buy enough and a little plastic tub and get a mix of the nuts, the tree nuts you like, macadamia, cashew, pecan almonds, walnuts, and mix them up, buy it up, and then bring it home. And like, that's much better than buying the pre-seasoned nuclear colored stuff that you have to rip out of a bag. That might taste great, but it has a lot of chemicals in it. 


[01:09:31] Buy the fresh stuff. I like to cook, so I'm just telling you, spread it out to a cookie sheet. Either drip a little olive oil on it, salt if you like it salty, and just roast it or you could put it into a cast iron pan and just get roasted by moving around. Just does not take long at all. And then you have your own nut mix, which you can then start adding things to it. Dried fruits, pieces of dark chocolate. And now you've made yourself a healthy snack that you might not have otherwise realized feeds your gut microbiome, helps your overall health. 


[01:10:03] And by the way, listen, what did we all come out of around the world as humans, like, four years ago is the great pandemic thing that made everybody realize how important our immune system is, if nothing else. Immune system suddenly became another part of our vocabulary. Look, forget about the pandemic. Let's talk about the common cold. Let's talk about the flu. Nobody wants to get sick. You want a good, strong, healthy immune system, your gut microbiome, healthy gut bacteria live inside the tube of the gut. They're inside the garden hose of your gut, in the wall of your gut, so imagine if you took your garden hose and you just cut it with a pair of garden shears. There's a wall. 


[01:10:41] Our immune system, 70% of our immune system is found inside the wall of our gut, 70. That's not what they taught me in medical school, but that's actually the case. And so, our gut bacteria talk directly to our immune system. And a good healthy bacteria system, good microbiome means a good healthy immune system. And so, if you want to be just generally immune, healthier, make sure your gut is healthy as well. Again, we're beginning to discover why the old adage of eating whole, fresh plant-based foods and some of the dried ones as well are good, some of the canned ones are good, is actually better for our health. A lot of it has to do with our gut microbiome. There's so many other reasons as well. 


[01:11:20] But because the microbiome has become part of the modern conversation, the lexicon, I think it's important to point out that this is not difficult. It's pretty easy because the foods that are good for our gut are all around us. 


[music]


Cynthia Thurlow: [01:11:36] Now, there's this other production of nitric oxide that's involved. And this is actually what I found so fascinating residing in the mouth. The oral microbiome is so important for nitric oxide production and how some of the things we do that we unknowingly are actually depleting or eradicating nitric oxide production or the ability to produce nitric oxide relevant to things as innocent as mouthwash. 


Dr. Nathan Bryan: [01:12:03] Yeah, well, I think what we have to start and what my approach has been much different in basic science. So, the scientific method of generating hypothesis and then testing I mean that doesn't work. That's why science really never translates into clinical medicine. So, what I've done a little bit differently is I take important clinical observations, what's indisputable clinical observations, and then work backwards to try to figure out mechanism. Why are we seeing that particular outcome with certain interventions. And about 20 years ago, it was first reported that if you use mouthwash, you see an increase in blood pressure. And that was a completely new paradigm to cardiologists and vascular doctors because how is the oral microbiome connected to the second-to-second regulation of blood pressure and blood flow? 


[01:12:49] So, then the question was, well, there has to be something in the mouth. Fast forward 25 years and we now know that it's the oral bacteria. And so, the human microbiome project is completely mapped. We understand the oral microbiome, the gut microbiome, the vaginal, the dermal microbiome. And so, the bacteria that live in and on our body outnumber our human cells 10 to 1. And these bacteria code for 3 million gene products and the human genome only codes for 23,000 gene products. So, these bacteria, as we know again through clinical observation, if you use antibiotic every day, what happens? People get systemic disease and they get sick because you're destroying the microbiome. 


[01:13:27] Well, the same thing happens in the mouth, if you destroy the oral microbiome and it shuts down nitric oxide production, your blood pressure goes up, you lose the protective benefits of exercise, you start to develop erectile dysfunction. And all the symptoms we talked about of nitric oxide deficiency, and that's when we intervened, I guess probably 20 years ago, started doing tongue scrapings, trying to figure out, number one, can we culture these bacteria, number two, can we then ascribe some type of metabolic function to them and then start to make predictive models on if you don't have these bacteria or you have some dysbiosis, what happens to nitric oxide production and what happens to your blood pressure? 


[01:14:03] And then we published, I think four years ago that if you use mouthwash, in young healthy patients with normal blood pressure for seven days, we can see almost a 26 mm increase in blood pressure, no change in diet. These are patients that are not on any drugs, drug therapy, prescription medications. We didn't change their diet. The only thing we did was give them mouthwash twice a day for seven days. And it made them clinically hypertensive. So that's the clear association between destroying the microbiome, decreasing nitric oxide production and an increase in blood pressure. So, mechanistically we certainly understand this. And now we can actually predict steady state blood pressure by the presence and number of, half a dozen or less bacteria in the mouth. So, it's a very powerful tool. 


Cynthia Thurlow: [01:14:50] It's really interesting because I think that for so many of those of us that have grown up during our lifetime time, we were all encouraged. My father used Listerine every single day for his entire life, his entire life he used Listerine. And even my husband, when we first met, used Listerine breath strips. And I managed to get him off of that. But how many people that are listening are unknowingly impacting such an important function in their body without even realizing it? And so, thank you so much for the work that you do. And let's talk a little bit about saliva. You mentioned that there is this complex interrelationship with the oral microbiome, how integral it is in activation of nitrate and then nitric oxide gas. How does that interplay with the digestive system overall? 


Nathan Bryan: [01:15:38] Yep. Well, again, let's start with indisputable clinical observation. This comes from epidemiology. So, it's known for many decades that people who eat a really healthy diet, mainly a plant-based diet, but there's other dietary patterns, a Japanese diet, for example, the dietary approaches to stop hypertension, those have important clinical outcomes. And so, for years, people thought, well, it's just the vitamins and the minerals and the antioxidants that are contained in those foods that recapitulate the clinical benefits. But when you do intervention studies and you try this antioxidant cocktail or mix that's found in vegetables, you fail to recapitulate the benefits of that certain diet. And now we know that it's due to the nitrate content in certain food and dietary patterns. 


[01:16:23] So, nitrate is a naturally occurring molecule. It's found in the soil. They're nitrifying bacteria that fix nitrogen or ammonia into nitrate. And then the plants that are grown in the soil assimilate this. And then when we consume it, as humans, we're denitrifiers. So, we basically denitrify that whole process. So, it works like this. So, if you eat say 100 g plate of spinach, when we chew that it's taken up into the stomach and as long as we have sufficient stomach acid production, then that food is digested. Proteins are broken down into amino acids. We can absorb things like selenium, chromium, B vitamin, zinc, iodine. And then when we get that acid load into the duodenum, that promotes bicarbonate secretion. So that's the entire acid-based balance on the human body. But in that proximal gut, the duodenum, nitrate is intentionally taken up and transported and put in our salivary glands. 


[01:17:18] And this takes about 90 minutes. So, from the time you consume a plate of salad or spinach or green leafy vegetables, 90 minutes later, now our salivary glands are secreting this nitrate. And this was first recognized in 1978 because cancer biologists were trying to understand why would the body intentionally concentrate nitrate in our salivary glands? Because 40 years ago, it was thought, well, nitrate forms nitrosamines. Nitrosamines cause cancer, therefore nitrate causes cancer. But now we know that the kidney reabsorbs nitrate. It's concentrated in our salivary glands. And now we know that the bacteria that live on the crypts of the tongue metabolize this nitrate into nitrite. And then when we swallow our saliva, it becomes nitric oxide gas. But we're 100% dependent upon the bacteria because humans do not have this enzyme. So again, this is another real world example of symbiosis. 


[01:18:08] The bacteria that live in and on our body are doing things essential to the human host, that we cannot do otherwise without the bacteria. So, if you wake up every morning and two out of three Americans do this and use mouthwash and kill the oral microbiome, now you've lost the protective benefits of a healthy diet. You lose the protective benefits of exercise, and your blood pressure will typically go up and bad things happen. You become nitric oxide deficient and even more. The problem is fluoride. Fluoride's antiseptic, just like Listerine. Listerine, if you look at the commercial, says kills 99.9 of the bacteria. And they flaunt that, they advertise that. [laughs] I mean, that's not a good thing. Fluoride does the same thing. It's an antiseptic. That's why they put it in municipal water, and that's why it's in your toothpaste. And it's a neurotoxin and it shuts down your thyroid function. So, you have to get rid of fluoride in your toothpaste and your drinking water, the water you bathe in, you cooking, and you have to stop using mouthwash. 


Cynthia Thurlow: [01:19:10] Yeah, and I think that these are practical things. I know that when my children were born and they were first seeing a pediatric dentist, one of the ways that we selected the dentist we ultimately used was someone that was open to the possibility of not doing fluoride treatments. And, when I presented the dentist, who is a good friend of mine, we talked about it openly and she said, I would say 50% of my patients at this point are not doing fluoride treatments on their children. And instead of how many others are just blindly following treatment recommendations without questioning some things that are going on. What other types of things? We talked about fluoride. We mentioned proton pump inhibitors. What other types of medications?


[01:19:49] I'm thinking about antibiotics as a huge class of drugs. Is it duration of use? Because I'm sure everyone listening has probably at least had one or two rounds of antibiotics, hopefully appropriately. But for individuals that maybe had a long, four to six weeks, maybe they had a tick-borne illness, they had Lyme disease, which is endemic in my state. I know that I had a hospitalization in 2019. I got six weeks of antibiotics and antifungals. I'm presuming at some point, if people are working to restore the vaginal, the oral and the gut microbiome, they can repopulate and refurbish the net impact on nitric oxide production. But what is the research saying specific about antibiotic therapy? 


Nathan Bryan: [01:20:31] Well, it's, as the name implies, it's antibiotic, antilife, [laughter] bacterial life. And so, I mean, there's a reason you don't take an antibiotic every day. Because as you mentioned, it destroys the microbiome. But look, if you have an infection and you don't want to get septic and die from this, especially when there's effective antibiotics out there to treat an infectious pathogen. But there's always collateral damage. And what we've found in the oral microbiome, and I think the [unintelligible 01:20:56] is in the gut microbiome or any microbiome, that these communities are extremely resilient. In our 2019 paper, we basically just took seven days of antiseptic mouthwash used, and then we stopped for four days. We brought these patients back after four days and then redid their tongue scrapings, reanalyzed their microbiome, reanalyzed their blood pressure. 


[01:21:16] What we found was four days off of the antiseptic. The communities had completely repopulated the blood pressure completely normalized. So, these communities are really resilient. If you stop shutting down their production and killing them off, then they basically repopulate. But I think it depends upon what we feed them. Obviously, the microbiome in the gut is much different than the microbiome in the mouth, which is much different than the microbiome in the vagina. So, we have to give those bugs what they need to flourish, to improve their ecology, to improve their diversity and let them do their job, support the biome, don't eradicate it. 


[music]


Cynthia Thurlow: [01:21:57] I really enjoyed reading your book. And one thing that really stood out to me, that you did a particularly great job, was discussing the role of pesticides and gut health. I don't think there's enough conversations around what exactly these herbicides and pesticides actually do to the gut microbiome. And I'm just going to read a statistic that really stood out to Me. Since 1974, 18.9 billion pound of glyphosate have been sprayed worldwide. What is it about glyphosate that is so toxic to our health and the health of our gut microbiome? 


Dr. Vincent Pedre: [01:22:34] You have to look at what the glyphosate molecule is. It's basically a mineral binder. We call it a chelator. That means that it binds minerals. And the way that it kills weeds is by starving them of nutrients. The thing is that same action actually if you look at patent on glyphosate, it's actually patented as antimicrobial agent because our microbes also need those minerals to function. So, when you ingest glyphosate, it's going to have several different effects inside the gut. And one of them is going to be it's going to disrupt the gut microbiome in the same way that antibiotic can disrupt it. 


[01:23:20] Maybe not to the same extreme that antibiotic can, but if you think about over a lifetime exposure and when you get an alteration in the balanced because if you think of the gut as this ecosystem, sometimes I tell patients that the gut is like a rainforest. And a rainforest depends on a balance of a lot of different types of plants and organisms in the ecosystem that keep the ecosystem in imbalance. And if you create an imbalance in that ecosystem, then that's going to cause a domino effect. And the domino effect that we get in the gut is that it starts with dysbiosis. So, an imbalance of good and bad bugs. So, there's maybe an over growth of certain types of bugs that tend to be opportunistic. When you take away some of the good ones. 


[01:24:15] And then when that happens, then the next thing that happens is a loss of integrity of the gut border and you start losing the mucus layer and that leads to intestinal permeability or leaky gut, which then is basically the top of the domino for many, many health conditions that affect everyone who's listening to this podcast. 


Cynthia Thurlow: [01:24:39] And where do you think most people are getting exposure to glyphosate? Obviously, we know that there is geographic propensity. Obviously, those in the Midwest are unknowingly probably exposed to more pesticides. And certainly, glyphosate or Roundup is its technical terminology. But what crops or what foods are exposing us to the most food sources that are impacting this pesticide load that we are experiencing? 


Dr. Vincent Pedre: [01:25:09] Yeah. And I think it's important to note that exposure to glyphosate can happen either orally. You ingest the food that has glyphosate residue on it, or you can inhale it. So, if you live in the Midwest and farmland or near farmland where glyphosate is being sprayed, it's going to be in the air also and it can be inhaled. But you also mentioned Roundup and you can go to Home Depot or Lowe's and buy Roundup weed killer and spray it on your lawn. And if you're doing that without some sort of N95 mask to protect yourself while you're spraying it, you're going to be inhaling glyphosate. And if your neighbors are doing this, so there's always like, “Well, where is this coming from?”


[01:25:57] Because I sometimes will do an environmental toxin panel on patients and check their glyphosate level as part of that. And I've been shocked to see how high glyphosate levels can be in a patient who is eating organic at home. Like being really careful. Because the crops that we know that are most likely to be sprayed with glyphosate-containing pesticide are the genetically modified crop. And the two biggest one in the US are soy and corn. But we also know that glyphosate is ubiquitous and it's being sprayed on a lot of different things. And it's also sprayed on wheat. So, a lot of wheat, nonorganic wheat, is going to be contaminated with glyphosate. 


[01:26:41] And I'd hate to say it, but if your organic farm is downwind from a GMO farm, some of that is going to get into the other crop because it's airborne. And soy and corn being some of the two biggest crops that we produce in the US and I was actually surprised. I was at this international microbiome congress in London many years back and there were some scientists from Korea and I was talking about glyphosate. I did a presentation actually on glyphosate and how most of the soy 90 some percent of the soy in the US. And they came up to me afterwards because they said, “Wait a second, Korea imports its soy from the US and I thought, “well, really, like you don't grow your own soy.” 


[01:27:36] They're like, “No, primarily they import soy from the US and they were asking like, “Wait a second, does that mean that we're importing genetically modified soy that has been sprayed with glyphosate?” And it was this big like wide eyed, like aha, like “Wait a second, what is going on here?” And so, I think it's important to also note this is a worldwide issue and there are some countries in the world that have outlawed the use of glyphosate, recognizing not only the harms that it causes because glyphosate being a chelating agent, it gets into the soil. And that's something else that I talk about in my book. You can see back here, GutSMART protocol, the importance of the soil with respect to our health. 


[01:28:22] And one thing that we see in the soil when there's been monoculture and overuse of glyphosate, because one thing that's happening is that the weeds are becoming more resistant to glyphosate. So, typically, a farm that's growing genetically modified produce is going to be using six times the amount of pesticide they would have otherwise used. Because they know like, “Oh, well, the crop can withstand it.” And we can really get rid of the weeds, but the weeds are becoming more resistant. And the problem is that because it's a chelating agent, it's chelating minerals in the soil. And the soil, you have to think of the soil also kind of like our gut. So, the gut has this incredible microbiome that lives symbiotically with us and is an important key element of creating health in our bodies. 


[01:29:17] Well, in the same way, the soil is like the guts of the earth. And in that soil, there are a whole bunch of different organisms, insects, earthworms, but also a lot of bacteria. And when it gets sprayed with glyphosate, you start seeing alterations in the bacterial profile in the soil to bacteria that are not so favorable. So, the environmental effects then cause effects in our food supply too. Because the minerals get chelated. So, the same crop that's been sprayed with glyphosate to get rid of the weeds is also going to be a mineral deficient crop because the glyphosate is chelating minerals that can't get into the plant. 


[01:29:59] So it's not going to be as robust and healthy as a crop that's been raised, using regenerative agriculture techniques, organic techniques, where the crop has to kind of develop its own antioxidants and be able to fight off things on its own. It's kind of like, I know you talk about this like hormesis. It's basically a crop that's being grown organically is having to encounter hormetic stressors that actually make that plant more robust. 


[01:30:29] So, the glyphosate in this and I explained this in my book. And actually, when I was writing my book, my editor asked me, “So what comes first? Is it dysbiosis? Is it leaky gut? Like, what is the order.” And in most instances, I think what's happening with people is they develop a dysbiosis. So, the ecosystem gets altered and then that altered ecosystem can no longer support a healthy gut barrier. And then you get leaky gut. Now there are exceptions to that because we know that over-the-counter medications that so many people take, ibuprofen, so NSAIDs for all sorts of aches and pains, those can directly increase gut permeability. And then we also know that if you develop certain autoantibodies as a result of having some sort of food poisoning. So, there's certain bacteria like Campylobacter, Salmonella, E. coli, Shigella that produce this toxin called Cytolethal distending toxin. So, a lot of people-- there's this big theory and Dr. Mark Pimentel talks about this, that he believes a lot of IBS follows some sort of food poisoning with one of these bugs that then what happens is that the body then starts developing antibodies to self because some of the [unintelligible 01:31:54] structures, so think of the scaffolding inside the cells that line the intestine gets broken down and then some of those proteins get exposed to our immune system, which is not used to seeing these intracellular proteins like actin and vinculin, which are just think of them as scaffolding, they're just whole holding the cell together and also holding the tight junctions between the cells which keep the gut barrier sealed. 


[01:32:21] So, they're these Velcro, like, very complex structures. And the body, if you develop antibodies to these proteins, it can start to degrade those connections and you can also get leaky gut through that fashion. It's cool because you can actually test for that in the blood and typically a patient that has this is going to be presenting more with diarrhea or with what we call mixed IBS. So, it's diarrhea, alternating constipation. If you're listening and you're someone who suffers from just constipation, like you're more of an IBS with constipation, then it's very unlikely that you have this issue. And really what it means is it's just differences in strategies on how to rebuild the gut lining. But that's basically the mechanism that's common to a lot of things. 


[01:33:17] So, you could replace glyphosate with antibiotic and it's the same domino effect the antibiotics coming in, it's really not just killing off bad bugs, it's killing off good bugs. And if that balance isn't restored and then that can lead to leaky gut as well. And of course, for anybody who's listening, sometimes you have to take an antibiotic, so I get that question all the time, like, well, what if I have a dental procedure and I have to take an antibiotic? And well, every time you take an antibiotic, you should be doing gut restoration afterwards. 


Cynthia Thurlow: [01:33:54] I agree wholeheartedly. And it's interesting because I feel like for those of us that are north of 40, oftentimes it's this cumulative exposure over time. You may not be aware of the insult of exposures to pesticides in the gut microbiome. You may take a couple courses of antibiotics. And I think both of us fervently believe there are instances where we need them. And I always use the example that in 2019 I had six weeks’ worth of antifungals and antibiotics and I think it's probably going to take me years to restore my gut microbiome back to where it was. Having said that, I think that it's helpful to talk through some of these things. Like as an example, one of the things you talk about in the book is 30% of antibiotics are unnecessary. And that's from the CDC. 


[01:34:40] That is not a contrived statistic. Helping us understand that there are many viruses that antibiotics are prescribed for and this contributes to antibiotic resistance. Helping us understand that sometimes we have to suffer with a stuffy nose for a couple days and we don't like that. We like this instantaneous gratification. But there are clearly instances where we need antibiotics. But understanding that 47 million prescriptions are written for antibiotics a year and not all of those instances do we actually need them. But what I thought was startling was that you mentioned one five-day course of Cipro will induce 12 months of dysbiosis. That's one five-day course. We're not even talking about a seven or a 10-day course. So, understanding that each time you are prescribed an antibiotic, it's magnifying these effects. 


[01:35:29] I think the one statistic that I heard after I was in the hospital was that it would probably be 18 to 36 months to get my gut, even being proactive about it, getting back to some restoration functionality where I was prior to appendicitis. And so, I think for many of us, we take the antibiotic and we don't think anything of it. But I do believe these cumulative insults can have a significant impact on where we are. 


Dr. Vincent Pedre [01:35:54] I also want to say that, because I think of myself as a gut biohacker and I'm also not a patient person. So, I like to shorten the time from disease to recovered and optimal again. And sometimes that does take time. But you have to think the person who's taking that course of antibiotics, what other obstacles to healing are they filling their bodies with? “Are they having a lot of sugar? Are they having a lot of dairy? They maybe gluten sensitive, but don't know it. It's sub threshold, so it's not obvious to them. And they're eating a lot of gluten and that's causing leaky gut along with some other health habits, lots of stress. 


[01:36:38] So, I think that there are ways to shorten that timeline and I talk about that in my book and there's definitely studies that are pointing us in that direction and just intuitively things I've done with myself and with patients. I got Giardia in Guatemala and I was deathly ill to the point where I needed IV fluids. And when I came back, there was nothing else that could make me well other than taking antiparasitic and antimicrobial. At that point, I was not feeling well and I knew if I needed to recover. So, sometimes you do need that antimicrobial. But as soon as I finish that, I was really focused on gut restoration. 


[01:37:23] And for me, because I understand myself and sometimes people, not everybody, might have this intuition, I just felt that I needed kefir. So, I started having kefir on a daily basis and which is unusual for me because I also don't usually do dairy kefir. But the intuition was you need kefir. Kefir generally will have a much higher probiotic count than yogurt will. And if it's a well-designed, you know, organic kefir, you can make it at home also. It's super simple to make and along with bone broth and just a very simple diet when your stomach is upset, I tend to favor white rice. I think it can be really settling for the stomach and you can either eat it hot or let it cool down like then develops resistant starch. And it's much better for your gut and for your metabolism. 


But the reason I bring this up is because I think it's really important to note that we can restore the gut and this might not be right for everyone because if you have histamine issues, it's not going to work for you. But if you don't have histamine issues, the best and quickest way to restore the gut after being on antimicrobials is to incorporate fermented foods. And there was a key study that I included in my book that was done at Stanford University. Now it was a small group of about 36 people, 18 in each arm. And they unfortunately didn't have a control group. So, they did a diet comparison. It was a fiber rich diet compared to a high-fermented foods diet. 


[01:39:01] I think they should have had a third group that didn't have any of these interventions or maybe just having like a general healthy diet. And the fiber rich group, they increase their fiber intake. Now some people only have like 10 g of fiber per day. So, the goal was to get to 40 g, somewhere in the 40, 45 g range. For some people entered the study that was quadrupling what they were taking. For some of them they were at 20, so it was double the amount of fiber. And then in the other group, what they had them do is increase their fermented foods. And it could be yogurt, I don't know if people know what this is, but vegetable brine drinks, where you're just drinking the water from a fermented vegetable or sauerkraut, things like that. 


[01:39:48] And they had them increase their intake to 4 to 6 cups per day, 4 to 6 servings. Typically, a person pre-study was having 0.4 servings of ferments per day. And they were looking at different markers, so they were looking at microbial diversity. So, when you're. So, when we're talking about recovering the gut, the main thing that we're thinking about is we need to restore microbial diversity. When you bring an antibiotic in, you're losing some of that diversity because the antibiotic is killing off a bunch of bugs. Not just the bad ones, but some of the good ones. 


[01:40:24] And so they were looking at microbial diversity as well as about 36 inflammatory markers. And they asked the question, “Which group is going to do better? Does the fiber rich versus the fermented group?” And in functional medicine we hear eat the rainbow, right? Eat as many vegetables of different colors. And a lot of that represents taking in a lot of fiber. And I honestly thought when I was reading the study that it was going to be the fiber rich group that was going to win. I felt like I was at a horse race or something. I'm thinking, “Okay, who's the winner here? The fiber rich or the fermented foods?” Like this is really important because this type of dietary guidance can make a huge difference in people's lives. 


[01:41:10] And so it was the high-fermented foods group that increased their microbial diversity the most, which was surprising, but I can explain why. And secondly, they dropped 36 inflammatory markers. Some of them they were looking at cellular activation, like cytokine activation of macrophages, things like that. So not just typical immune activation, but actually cellular, what we call cellular immune activation, so innate immune system. So was able to bring that under control. And the interesting thing is, so this study was done over the course of 17 weeks with about a four-week ramp up and then a six week. They didn't go from like 0.4 servings to 4 to 6. 


[01:41:57] They ramped it up because one of the most common symptoms as people increase fermented foods is they're going to feel a little bit more bloated and gassy. What they found was that after about two to three weeks that leveled off and they didn't feel that anymore, they felt fine. And so, they stayed at that high level for six weeks and then they had a washout for seven weeks. And then they looked at all of these markers. And the key here is it was a small group, right? So, it wasn't a big study, was mostly women. So, it wasn't diversified in terms of who the participants were, mostly white women. But it does start to point us in a direction. Now the fiber rich group was interesting because they decided, well, are they all the same? 


[01:42:45] Was everybody in the fiber rich group? And they weren't. They actually were able to divide them in post analysis to three groups, one with high diversity of the beginning, middle and low. And so, then they looked at, well, what happened to these groups as you added more fiber. If they started with high diversity, they actually had favorable immunomodulation. So, the fiber came in and seemed to control the immune response, regulate it. If they had low diversity, when they increased fiber, it actually activated the immune system. It's quite interesting. So, it did the opposite effect. 


[01:43:21] So, diversity itself has an influence on baseline, on how our immune system is functioning. And obviously with the fermented foods group, it shows that it lowers inflammatory markers. And I know you talk about this a lot. Inflammation is the one underlying cause for all chronic degenerative disease. So, if we're going to make a difference in chronic degenerative disease, then the question from this study is do we need to be thinking about fermented foods? Now I take it a step further and think, is it really ferments versus fiber? And I don't think it should be one against the other. I think it's actually both. We should be increasing both. And we probably don't have to increase the fermented foods. Four to six servings is quite a lot. If you just increase it to maybe two or three servings per day with more fiber, then you're having this aggregate effect. 


[01:44:17] One of the critiques on the study said that maybe the fiber rich group just needed more time to show the changes. Maybe it just didn't kick in. But the reason that you might be wondering, well, why having yogurt or fermented drink that only has maybe one or two different bacterial lineages, like Lactobacillus bulgaricus or Acidophilus or something like, why is that increasing diversity? And it turns out that those bacteria feed other bacteria and they come in and they control the environment inside the gut and it creates this environment where it just promotes the growth and diversity of a lot of different bacteria that are not in the ferment itself. So, it's interesting to think that because we used to think like, just have a fermented food that's just going to increase the presence of that one bacteria. But it's not how it works. They're this interconnected network and they are supporting each other in different ways. 


[01:45:20] Some of them produce these postbiotic products that then feed other bacteria that then help increase the bifidobacteria or some of the clostridial species that are favorable in our gut. So, if you are on antibiotics and you're looking to recover, and I write this about in my book, you really, if you don't have any histamine issues, want to work on increasing your fermented foods and of course your fiber as well as tolerated. And I think that's the fastest path to recovering the gut, especially if you can make at home than making your own ferments. 


Cynthia Thurlow: [01:45:57] Yeah, it's interesting because I think about the questions that we get and I allow my listeners to ask questions ahead of time when I share which guests are coming on. And one of the very specific questions was, “I know that I'm histamine sensitive, I guess is the terminology they used. So, if someone's listening and they've been on antibiotics or they know they're working diligently on gut health, but they have to be conscientious about histamine-laden foods, do you have a workaround or suggestions for them? 


Dr. Vincent Pedre: [01:46:27] Absolutely. So, anybody who is histamine sensitive, their gut lining is not producing enough diamine oxidase. So, it's an enzyme that helps break down histamines in food. So, more histamine foods and histamine provoking foods, obviously you want to keep those low, but really the underlying problem is that the gut and the gut lining and the lack of diversity of the gut microbiome. So, then you say, well, but you just told me the best way to increase diversity is by eating fermented foods which are high in histamine, which are going to trigger my histamine issues. So, what do I do? Well, we have to biohack it and we've got to go in through the back door. The back door is rebuild the mucus layer. And we can do that. 


[01:47:14] There's been some great research on how bioflavonoids can help rebuild the mucus layer. So, like pomegranate is probably one of the best ones. Pomegranate arils or pomegranate extract that has been shown to help improve the integrity of the mucus layer. And it doesn't get metabolized into methane or carbon dioxide. So, it does not produce gas, which is nice because a lot of these people who have histamine issues are also very bloated. So, you don't want to give them too much prebiotic fiber because they're going to start feeling really horrible. These are the people who are also sensitive to onions, garlic, they have to be really careful with cruciferous vegetables. So, you want to emphasize in people like this, what you want to emphasize is things like that are bioflavonoid rich like pomegranate and also citrus bioflavonoids. 


[01:48:09] And there's actually some supplements out there that have pomegranate extract and citrus bioflavonoid extracts that can be used to start to gently, this is not an overnight thing, but what we're doing is it helps to rebuild that mucin layer. If you think of the gut lining as it's just this one cell layer thick. And there are certain cells called goblet cells that are secreting the mucus. And there's an inner and an outer layer of mucus. When you're sick and when things are off and you've got leaky gut, the mucus layer has broken down. And that inner layer mucus has bacteria. Now, that inner layer mucus should always be free of bacteria. It's like a protected zone. So, having things that are rich in bioflavonoids, these antioxidants, can help start to rebuild that. 


[01:49:03] And I just want to just quickly mention just pig-tailing on the alcohol that if you're someone that is, “Doing everything right,” but you just can't lose weight, the devil is in the details, as I like to say. And there's a detail that's in your blind spot. So, if you think you're doing everything right and you're not losing weight, and you're stuck, there's something that you're not seeing. And you might see it if you just start journaling, everything that you drink and eat and all the thoughts that you're having and how much stress you're under and how often you're pooping. So, you can do a mood food and poop journal. And sometimes by doing that, you can finally see a pattern and you can shine a spotlight on what you might be missing. 


[01:49:56] If you're at home and you're struggling and you're wondering, I think I'm doing everything right, but you're still having that glass of wine on the weekends, whatever it is. Because I think as a functional medicine provider, what I do, and I think what we do as functional medicine providers is we basically look for the areas that are hidden in the shadows that a person is in pain and tension to or the details that have been missed that are actually playing a bigger role then they think. Because a lot of times there are certain details that are downplayed. Now the idea of calorie extraction is really interesting because technically, if your microbiome can extract more calories from your food, then you're going to absorb more calories and potentially gain more weight.


[01:50:47] And there's certain bacteria that do that more easily than others. And it's a really great question. I started as a chubby kid, eating a lot of sugar, a lot of dairy, a lot of bread, a pizza, hamburgers, milkshakes, all that. And when I went through my puberty growth spurt, I became really thin and then I could never regain the weight. Now there could be a lot of different factors in that. So, I think it's not just the bacteria. I know looking back that my gut was damaged and I had developed a sensitivity to dairy and wheat. And so, I think we can't micronize it to just the bacteria. 


[01:51:32] I think it also has to do with leaky gut and if leaky gut is present and what types of foods the person is eating as well. So, I think it's a bit more complicated than just saying, like, “Oh, you've got microbiome that is a high extraction microbiome. So that's why you're gaining weight.” I always go back and look at it holistically, like, what else is going on? Is there leaky gut in this person and is there toxicity that needs to be detoxed and is there mental toxicity that needs to be worked on? Mindset, the thoughts that they hold. We think of the food that we feed ourselves. We also have to think about the thoughts that we feed ourselves and how that affects our entire bodies. 


Cynthia Thurlow: [01:52:16] So, important. Now I'd love for you to talk about your experiences that you had in Africa. I know really at the crux of when the pandemic was starting, you made a trip to Africa. And this is a story that I thought was really interesting to be able to share with listeners and tie up our conversation today. What did you learn about being with that indigenous tribe that you spent time with? 


Dr. Vincent Pedre: [01:52:37] That was an amazing experience and I'm so grateful that I was able to have that experience right before the world shut down. So, I was in Africa in February of 2020, very soon after what happened and the world came to a pause and I had the really incredible privilege to go visit the Hadza, the hunter-gatherers that live in the region of Tanzania and near Kenya as well. And they're hunter-gatherers that are still living in the way that their ancestors lived traditionally, living off of the land. 


[01:53:17] They don't grow their own vegetables, but they forage for things like root vegetables that look kind of like we would think of them as potatoes or tubers or the one that I tried while I was there and I went hunting and foraging with them, was very similar to like jicama. It was very watery and crunchy on the inside. And I think it's important also to note that 95% of our history as humans, we were hunter-gatherers. So, it's only this very last bit where we domesticated animals and started domesticating agriculture and growing mass agriculture for the big chunk of our history, we were hunter-gatherers. And so maybe we can learn something from these hunter-gatherers. Why are they so fascinating? 


[01:54:08] There's several things and the reason that I really wanted to go on this trip when I was presented with the opportunity, because I had already heard a presentation on studies that had been done on the gut microbiome of the Hadza and found that it was incredibly diverse. It had different types of bacteria. And actually, bacteria that produce different types of short chain fatty acids are more predominant, different ones. One called propionate, which is not typical to find in the western. And actually, sometimes propionate has been associated with autism. But interestingly, they make a lot of propionate. And it turns out that propionate helps with gluconeogenesis in the liver, so it helps them when they're not eating for hours and they're out on the hunt. So, they think that the propionate helps to keep blood sugar levels steady. 


[01:55:02] It's also really interesting that their gut microbiome is very different in the sense that the types of bacteria that predominate are different. And for example, something that we would consider a pathogen like Treponema, the bacteria that causes, for example, syphilis, they have that in their gut. And the species of Treponema that they have is actually quite important because it's able to break down vegetable fibers. And since they eat a very high fiber diet, it's serving a purpose in their gut to help break down the incredible amount of fiber that they're eating because they're chewing these tubers, they eat baobab fruit, they're foraging for these wild berries and they get also wild honey, along with small to medium size and sometimes large land animals. But they're eating a lot of fiber daily. 


[01:55:55] Interestingly and also because the men are the hunters and the women stay behind. The gut microbiome, unlike in almost every other society-- In every society, the gut microbiome of a male-female couple is very similar. And if they're living together eating similar foods, but with the Hadza, the women eat more fiber, they're eating more tubers, they're back home in the camp. So, their gut microbiome has a bit higher predominance of these Treponema than the hunters, than the men. So, it's interesting also to see how the diet shapes the gut microbiome. And I also think that there's another piece to it that I think is really important and a lesson that we can take from them. They're living out in the wild, they're out in nature, they're getting exposed to dirt-- they're digging things with their hands. 


[01:56:52] They don't know anything about hand sanitizer, they don't wash their hands if they come back having killed animal and they have blood on their hands, like there's no concept of that. So, there's a lot of exposure to the natural microbiome of their environment, which I'd like to think that I was there and you're in the middle of the savannah, it's a semiarid type place. There areas that are oasis that are green, but it's also arid as well. I like to think they're not being exposed to pesticides and they haven't been the by and large, not exposed to antimicrobials. 


[01:57:31] They do have their own herbs that they use to treat members when they get sick, but they haven't been exposed to antibiotics in the way that we have in the west and they're not getting exposed to pesticides we hope. Part of the influence of that is the exposure to nature to allowing themselves to be dirty, to be exposed to dirt. And I think we need some of that in our modern lives. Like getting out into nature, getting exposed to dirt. Obviously, it's a bit more riddled with nuances because if you live in a pesticide-ridden area, it's not going to be so healthy for you. But if you're somewhere where you can go out hiking in the mountains or get away in nature or like I do, I have my own garden with organic soil and organic vegetables. 


[01:58:21] And sometimes I'll wash them, but I'll leave maybe a little bit of the dirt on there. And because that's going to diversify my gut microbiome, you're getting some of those soil microbes which are also really important for the diversity of the gut microbiome. And I think that's partly why the Hadza have such a diverse microbiome because they're not eating the rainbow. I basically told you what they eat. They're eating tubers, honey, wild honey, they eat wild berries, they're eating baobab fruit, and small to medium-sized animals. So, they don't have an incredibly diverse diet or access to the diversity of foods that we have. And yet they have an incredibly diverse gut microbiome and they don't have obesity, diabetes, heart disease, cancer, like all of the diseases that we associate with the western world. You don't see that in them. 


Cynthia Thurlow: [01:59:17] It's really interesting. I had the opportunity to be in Tanzania in 2021, and for where we were traveling to Zanzibar, but we did actually get to interact. And they're incredibly tall. That was the thing, being a very short person, they were very tall for me and very thin, but they were so incredibly healthy looking. And I think we have such a biased perspective even as clinicians because most of what we see in the United States is a great deal of metabolic disease, chronic inflammation, etc. One thing I want touch on is you mentioned, this over sanitization and triclosan was something that during the pandemic, everywhere you went, the expectation was you were going to be using this. What's interesting is it's not as benign as people think it is. 


[02:00:01] That in and of itself can actually alter our gut microbiome. So, I'd love to end the conversation talking about this over sanitization and why, as you mentioned, don't feel like you have to be perfectly washing your hands all the time, even if you're pulling things out of the garden, the dirt that we're exposed to in many ways can beneficial. 


Dr. Vincent Pedre: [02:00:19] Yeah, yeah. And again, as long as that dirt hasn't been sprayed with pesticides, [Cynthia laughs]. So, you have to know what dirt you're getting exposed to. They've shown in studies that the triclosan and antibacterial soaps actually causes alterations in the gut microbiome. So, we are what we eat and what we inhale, what we touch. So, things can get into the body in different ways. They don't only have to get in through the mouth, you can breathe them in, you can touch them and they diffuse through the skin. So, even something like triclosan can cause alterations and problems with the gut microbiome. And honestly, you do just fine using a regular soap without any antibacterial added to it to wash your hands. 


[02:01:07] And you don't want to wash your hands too much because then you start removing the oils that are on the skin that actually form part of the protective barrier of the skin and help support the microbiome that's in the hands. And actually, if you look at your hands, the microbiome actually here, it's more like a desert with oasis and every part where there's a line, that's where the microbes are hanging out. And in between, where there are less lines, there's not as many microbes. You don't want to be one of these people who over-- And the same thing with hand sanitizers that are full of alcohol. They're going to basically dry out the hand and take away all the oils which form a protective barrier for the hands. 


[02:01:54] So, I've seen people, who are a bit more obsessive about that, washing their hands all the time. And you look at their hands and they're all cracked and they're pink and they're red and they don't look healthy because they're overdoing anything is not good. My grandfather, who lived to 99s, and I would ask him, “Well, what's the key to long life?” And he said, “moderation.” I think that's very good advice. Taking anything too extreme can be too much. And certainly, washing hands, you really only need hand soap. And you don't have to do it as often as you think. And thinking that if you're sanitizing all surfaces, that's going to protect you, it's likely not. 


Cynthia Thurlow: [02:02:40] If you love this podcast episode, please leave a rating and review. Subscribe and tell a friend. 



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Anaya patel
Anaya patel
6 days ago

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