Dhru Purohit Show - Prevent Disease with These Simple Immunity Boosting Habits with Dr. Robynne Chutkan

Episode Date: October 27, 2022

This episode is brought to you by BiOptimizers and InsideTracker. Multiple studies have now confirmed a dramatic link between the health of our microbiome and the strength of our immune system. Low-fiber diets, limited exposure to nature, and overzealous use of pharmaceuticals have messed up our microbiome, making many of us more susceptible to viruses than we naturally should be. But the good news is that, unlike our genes, our microbiome is constantly evolving, offering a pathway back to health for those who are suffering and proven protection for those who want to stay well.  Today on The Dhru Purohit Podcast, Dhru talks to Dr. Robynne Chutkan about why some people get sicker from viruses than others, the connection between the health of our microbiome and our likelihood of catching viral illnesses, and daily habits to boost your immune system and maximize your gut health. Dr. Chutkan is one of the most recognizable gastroenterologists working in America today. She has a BS from Yale and an MD from Columbia, is a faculty member at Georgetown University Hospital, and is the founder of the Digestive Center for Wellness. In this episode, we dive into: -Why some people get sicker from viruses than others (3:17) -Why taking acid-blocking drugs increases your risk of catching viruses (7:48) -The role viruses play in our body (9:46)  -The protective effects of some viruses (15:26) -Microbial predictability (23:50) -The importance of eating a diverse diet to improve gut bacteria (26:46) -The specific carbohydrate diet study for improving inflammatory bowel disease (31:43) -The role short-chain fatty acids play when it comes to the strength of our gut microbiome (39:43) -How to improve bloating symptoms (44:55) -The role mucus plays when it comes to fighting viruses (50:01) -How fevers halt viral replication (54:35) -Understanding long Covid and post-viral syndrome (1:17:08) For more on Dr. Robynne Chutkan, follow her on Instagram @gutbliss, Facebook @drrobynnechutkan, Twitter @drchutkan, and through her website, robynnechutkan.com. Get her book, The Anti-Viral Gut, here. This episode is brought to you by BiOptimizers and InsideTracker. Magnesium Breakthrough really stands out from the other magnesium supplements out there. BiOptimizers is offering my community 10% off, so just head over to magbreakthrough.com/dhru with code DHRU10. InsideTracker provides detailed nutrition and lifestyle guidance based on your individual needs. Right now, they’re offering my podcast community 20% off. Just go to insidetracker.com/DHRU to get your discount and try it out for yourself. Hosted on Acast. See acast.com/privacy for more information. Learn more about your ad choices. Visit megaphone.fm/adchoices

It's not just digestion that stomach acid is important for. It's also one of the most important defenses for killing viruses that get into your body. But the problem is that so many people are taking these acid blocking drugs. Hi, everyone, Drew Brode here. You want to know what's crazy? Even though we know so much about the connection between our immune system and our gut, even though the science on the microbiome and gut health and the importance of gut health has exploded in the last 20 years, we still have.

some weird messaging, some crazy messaging when you turn on the news, hopefully you're not watching too much, or you open up the paper and you look at the mainstream approach of the advice and the messaging around protecting our immune system from pathogens and viruses and all that other stuff. So much of the subtext that's out there today, and sometimes it isn't even subtext, it's straight up, overt text, is your body is weak. Your immune system is not strong. You're super vulnerable. and if you don't rely on an outside crutch, you cannot protect yourself. And today's podcast with Dr. Robin Chutkin, one of the foremost recognizable gastroenterologist working today, is how that couldn't be further from the truth.

Your body is not weak. Your body, under the right conditions, we're talking about what those conditions are today, under the right conditions, your body is incredibly strong. Your body is resilient. And the key to fighting off pathogens, viruses, overflow of bad bacteria starts from the inside out. I think it was Socrates who said health and disease starts in the gut. And today, our guest, Dr. Robin Chutkin, is reminding us that that is not only true, but that advice is more needed than ever before. So a little bit about Robin.

Robin has a Bachelor of Science from Yale, and she has her medical degree from Columbia. and she's a faculty member at Georgetown University Hospital and the founder of the Digestive Center for Wellness. She is super passionate about gut health and reminding people how their immune system starts in the gut. And if they care about increasing their chances of fighting off the flu, the common cold, and yes, pandemic-level viruses, they need to get their gut health strong. So if you know somebody that is always dealing with the flu or getting the cold during cold season, maybe that person's you. This episode is going to be a fantastic listen because Dr. Chuckkin walks us through a ton of practical advice that we can all follow starting today on how to improve your gut health. What all the research and the evidence that she's come across has shown her. Now, a little bit

more about Robin before we jump in. She's an avid runner, yogi, squash player and she's passionate about introducing more dirt, sweat, and vegetables into people's lives. I love that. We all need a little bit more dirt, sweat, and vegetables. Vegetables are great. Robin also has a new book It's called the antiviral gut tackling pathogens from the inside out. We're going to deep dive into that book and some of the lessons that are included in it today. I hope you enjoy. Stay tuned. Dr. Chuckin, welcome to the podcast.

It's a pleasure to have you here. I've been loving the new book, your team sent it over. And really the essence that I get from the book is that why do, the question really is, why do some people get sicker from viruses and not just like the pandemic that we all experience, although that's a big part of it, but even things like, why do some people get the cold more often than other people? And what is it that healthy people are doing to either make themselves stay sicker less longer or in some cases avoid getting sick, both from chronic conditions and also these viral issues. And most importantly, how can we, the people that are

listening today, how can they turn themselves into a virus slaying machine? A virus slaying machine. So welcome. It's a pleasure to have you here. Give us a couple highlights right off the back of some things that people might be doing today that are preventing them from becoming a virus slaying machine. Well, Drew, first of all, thank you so much for having me. This is going to be so much fun, I can tell. One of the things people don't realize about stomach acid is that stomach acid is there to protect you. Well, it's also there to digest food, right? So stomach acid is digestion 101. Your digestive enzymes can't work properly if the pH in your stomach is not sufficiently low. So if you don't have a sufficiently acidic milieu, your amylase,

your lipase, the pepsin, none of these digestive enzymes will work properly. You're not going to digest the food. So it is essential to digestion, but it's not just digestion that stomach acid is important for. It's also one of the most important defenses for killing viruses that get into your body. And how does stomach acid denatures a viral protein? So we're all familiar. We've all become sort of armchair virologists, unfortunately, in the last couple years. And we're familiar with those spike proteins on the SARS-CoV-2 virus. Stomach acid denatures those proteins, renders the virus inactive. But the problem is that so many people are taking these acid-blocking drugs. And I'm not talking about an occasional antacid. I'm talking about a class of drugs called

proton pump inhibitors. You may know it as a little purple pill, so drugs like nexium, prilisec, pepsid, acid, or a whole bunch of them on the market. These drugs are exceedingly popular. At one time, they were amongst, and they're probably still in the top 10, but they were amongst the top three most commonly prescribed drugs in the world. And that's because these drugs really work. They are fantastic at doing what they're supposed to do, which is blocking stomach acid. They completely shut down that stomach acid pump. And so they create a nice alkaline environment. And that's great if you want to eat a cheeseburger at 10 o'clock at night, have a pepperoni pizza at 1 a.m. and all these things you probably should not be doing, because it means that you don't get

stomach acid regurgitating up into the esophagus and burning your esophagus, so these drugs get rid of that heartburn feeling. The problem, though, of course, is they leave you defenseless, because now you have an alkaline environment that instead of being hostile and killing off viruses is friendly and allowing viruses, as well as other pathogens, types of bacteria to overgrow. So we've known for decades, actually, if you think about cruise ship outbreaks from 10 or 20 years ago, pretty typical that you'd have a cruise ship with maybe 3 or 4,000 people on board, but only 1,500 of them would come down with rotavirus or Norwalk virus or whatever the viral outbreak was. And what is it about the 1,500 versus the other 2,500?

And so, of course, things like extremes of age, right? The very old, where the immune system is waning, the very young. where it's waxing, people who are immunocompromise because of conditions. Maybe they have cancer or diabetes, or they're taking a medication that can suppress their immune system. But there's a whole other category of basically healthy people. And a significant number of those people are people taking acid-blocking drugs. So we have been able to predict when we look at enteric diseases.

So basically, enteric infections that infect the gastrointestinal. system. So campelobacter, Clostridium difficile, which we can see in hospitals, viral infections. We've always seen a particularly high risk in people taking these acid-blocking drugs. So in the summer of 2020, when a large population-based study, 54,000 patients came out looking at the risk of acid-blocking drugs relative to getting COVID, they found that people taking these proton pump inhibitors once a day had double the risk of testing positive for COVID. And if you were taking these drugs twice a day, as many people do, the risk was up to three or fourfold. So for those of us in the gastroenterology community, this wasn't a huge surprise because

again, Drew, we'd been seeing this for decades. We'd been seeing that people who don't have stomach acid are increased risk for foodborne illnesses, for hospital-acquired illnesses, etc. So it wasn't a huge surprise to us, although I will say it was a surprise to me how high the risk was. And so, you know, nothing is free, as I have to tell my patients all the time. So there are people who really need these drugs. There's certain conditions, their pre-malignant conditions of the esophagus and some other conditions where you really need to block stomach acid. But for the vast majority of people taking these drugs, their diet and lifestyle things that they can do to help with their heartburn and their acid reflux so that they can

either take a lower dose or maybe not use these drugs at all, or maybe take an antitherto. Or maybe take an antacid or a drug that you can use on demand only when you're having the symptoms and not a drug that you would take every day that would completely block your acid. So, you know, there are things like this in terms of how we think about these things that our body does. Our body produces stomach acid for some really important reasons. And so part of the goal of the book is really to have people think differently about these processes that are going on in their body, right? what is a role of stomach acid? What is it doing for me? And what's going to happen if I sabotage it, if I block stomach acid and now don't have that defense? And zooming out a little bit,

first of all, that's fascinating, by the way. And I have a bunch of follow-up questions on stomach acid. We'll come back to that. And as I was saying, zooming out a little bit, you're not just helping people think differently about things like stomach acid. You're also helping people think differently about viruses in general. So one thing that it's important to chat about a little bit is that, you know, your first few books were focused on taking us through this history of how for such a long time we were in this anti-bacterial phase. And then finally, we understood that we shouldn't always be thinking antibacterial, that bacteria can be friendly inside of the body and are crucial inside of the body, right? There's beneficial bacteria. Sure, there might be

some bacteria that we don't want, but we don't want to leave these sterile lives. In that same way, you're helping us understand that viruses play a crucial. role in our body. Can you talk a little bit more about that? This episode is brought to you by Inside Tracker. You know, I just turned 40 this year. I can honestly say I've never felt better. So many people have this fear of getting older because they think it has to come with chronic disease and deteriorating mental and physical health. If that were the case, I'd be worried about getting older too, but it doesn't have to be that way. It's possible to get older and stay young at the same time. But sometimes we just need a little help knowing exactly how to do it. That's

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sleep is ultimately what matters the most, which is why I love wearing my whoop device. WOOP is a personalized digital fitness tracker and health coach platform that monitors your physiology 24-7. Woop helps me figure out my ideal sleeping schedule and gives me a sleep score every morning that's based on how the sleep I get compares with the sleep my body actually needs based on my activity from that day. Woop also monitors my heart rate variability, resting heart rate, and respiratory rate, and uses these numbers to give me a recovery score. This recovery score number lets me know how hard I can push my body the next day, which is very important for me to manage my expectations and feel my best. And it calculates my physical stressors and gives me a strain score, which is super helpful for giving me the nudge I need on busy weeks to make fitness a priority.

Right now, WOOP is offering my community 15% off their WOOP membership. Just go to join.wop.com and use the code Drew 15 at checkout. That's join.w.w-O-O-P.com and enter the code D-H-R-U-15 at checkout for 15% off any WOOP membership. Yeah, absolutely. And again, in this spirit of we've all become armchair virologists, this concept of the virome. So first of all, I think the first thing I want people to know about viruses is that our bodies are brimming with them. We have even more viruses in our body than we have bacteria. And, you know, we have a lot of bacteria. And there are all kinds of grandiose numbers you can come up with, more than stars in the universe. And that's a lot.

My 17-year-old would tell me that's a lot. But she's always commenting on my lack of knowledge about astrology. But we have lots of viruses. And they're not just in our body. They're everywhere in the environment. So there are viruses in seawater in the Sahara everywhere. 10% of our human genome is made up a viral tissue. And that's because viruses have been around for millions of years and they've been around infecting us for millions of years. And over time,

some of that viral material can actually incorporate into our own genetic material. So for example, if a virus infects sperm cell or an ovarian cell, it can incorporate into our genetic material. And what's really fascinating is we know that a lot of that viral material that's part of our genetic code is actually there to help protect us. So certain placental proteins to do with the reproduction, even the way memory is formed, that has to do with some of the viral protein that is in our, but essentially part of our genetic code. So just like bacteria, like you pointed out, that most bacteria are actually very much invested in our health and keeping us healthy, the same is true for viruses. And of course, there's some bad players out there. And, of course, there's

some bad players out there, right? Ebola, SARS-CoV-2, there's some you want to avoid. But this scorched earth approach, this idea that you go out and you just kill every virus in your path, not only is it not necessary, it's a bad idea because you're going to destroy some of these healthy viruses and bacteria in the process. There was a great New York Times article we'll link to in the show notes that came out about, I think, like 10 years ago, and it was saying, you know, for the longest time, there was this 10% of the human DNA that scientists were like, what is this for? And they would call it junk DNA. And then much later on, they started understanding that actually this is related directly to viral DNA, that has become part of us as

you were sharing. And I think that really brings up the question, even for things like COVID-Sars COVID-2, which of course wreaked so much havoc in this world. But can we just so easily label something as bad. Do we know the reason that we're getting sick, even with things like the common flu or cold or other things like that, is some part of it actually adding to our resilience in our body? So that's my question for you. Yeah, you're so right about that. And a great example of that on the bacterial side is a bacteria that most people have heard about called H. Pylori, helicobacter pylori. And we know that a gastroenterologist actually was one of the winners of a Nobel Prize for his work, Dr. Marshall, looking at the role of Helicobectopacta pylori in causing stomach ulcers and being linked to

stomach cancer. And that's all true. H. Pylori is implicated in the formation of stomach ulcers and in certain people can be linked to stomach cancer. But H. Pylori also turns out to have some protective effects. And it turns out that this whole, you know, in the GI world, a couple decades ago, when sort of all the discovery about H. Pylori was made. And in the true gastroenterology tradition, he discovered this by drinking some H. pylori. So you know gastroenterologists, we're very scatological. Where I was like, oh, yeah, let's drink some H. Pylori. Let's sample some of the stool, right?

So my friends are always like, did you wash your hands? Like, what have you been doing playing in stool? But so for H. Pylori, for decades, this sort of Dictum and G.I.I. was the only good H. Pylori is a dead H. Pylori. and we literally went on this search and destroy mission to find H. Pylori in people's stomachs and to eradicate it using a lot of antibiotics generally. Well, it turned out that that is probably not such a great idea because in some people, depending on the setting, and particularly early on in life, H. Pylori may actually play a protective role. And it depends on not just the age,

but geographically, people in South America. H. Pylori plays a different role from people in North America, and the acquisition rate is about 10% per decade. So as you go through life, you know, by the time you're 60 or 70, you have about a 60 to 70% chance of having it. So the context in which we look at these things and, you know, the idea that you can draw a straight line between an illness and a pathogen, whether it's a virus or bacteria, it's a really zigzag line. So we've added to Pasteur's germ theory, right? The idea that germ gets into your body, it causes diseases with this concept of terrain theory. So what does your soil look like? What's going on with your microbiome and your immune system? And what is the context? Because it turns out that some

viruses actually, and this is a point you're getting to Drew or you were making, some viruses actually confer benefit. So for example, if we look at herpes simplex, there's certain strains of herpes simplex virus that protect us from bubonic plague. Now, fortunately, bubonic plague is not something that most of us have to worry about. But it turns out that that's a result of generations and generations and it getting baked into the genome of protective effects from viral infections back when things like your synia pestis that caused bubonic plague were actually a problem. So certain viruses can confer protection. There's certain viruses that can make you less likely to get HIV. And, you know, speaking of this sort of genetic viral interplay, there's some people who are

are immune to viruses like HIV, and no matter how many times they get infected, they will never get HIV. It can be as high as 10% of some European populations. And it turns out that that protective effect harkens back to ancestors who had bubonic plague and survived and what got into the genome. So, you know, I really caution people to not look at this in the sort of black or white, you know, viruses are bad. We need to destroy them. And to take a more nuanced and comprehensive approach when we're looking at these things. You know, when you read your book and you go through that and you walk away with that nuanced understanding of things, really, I feel like one of the main takeaways for the audience is that

we are not victims to this scary world of viruses that are out there that are trying to get us for some reason that we don't understand. If you watch the news at all in the last few years, that's a little bit of the sentiment. And that's the subtext is that you. are not strong enough, your body's not capable enough, and of course, not even really initially really distinguishing between older people and younger people and a little bit of the public messaging. And it's like you're a victim and you're super susceptible and just isolate away and just protect yourself and primarily rely. Again, therapeutics have their

role in place, but primarily rely on some sort of therapeutic. And the message that I'm from your book, especially when you walk away from the soil and seed analogy, is that actually our terrain is a lot of what depends on what gets invited in and grows versus what stays out. Yeah, you're so right about that, the sort of scare tactics. And that was one of the main motivations for writing the book, actually, is I want people, I mean, I don't want people to be foolish, right? As I like to say, I am not one of those people who walks into the zoo and thinks, I can make friends with a lion, and the lion's not going to hurt me. The lion knows. I come in peace, although I kind of do joke about that with my family. I'm a scientist, and I understand

that some of these viruses can be really dangerous. But at the same time, you know, scaring people is really great for news ratings and ad revenue, et cetera. And one of the main motivations is that I want people to be informed. Because once you're informed and you understand how this all works, it is a lot less scary. And so the goal is, a, you know, as you said, what can you do to limit your exposure, right? And following public health guidelines is really important, whether that's a quarantine, social distancing, et cetera. And if I could add just something in that, to an extent, right, just meaning like if somebody's telling, you know, there's also a counter component of that, is that, you know, especially if you're like younger and you're not seeing people and other stuff.

So within everything, just like you were sharing so beautifully, there's nuance within everything that's there. And absolutely, we have to do a more strategic risk approach. And that's unfortunately something we haven't seen, right? It was like everybody go inside, take cover. There was less personalization. I think that'll be an important lesson that comes from this and there's more people like yourself that are speaking about that. And we're seeing it already. We're seeing it. Like in the schools, you know, we're seeing like not just sort of mandatory testing masks all the time. But, you know, as Dr. Walensky from the CDC has said, it's like an umbrella, right? You bring it out when it's raining. you put it down when it's not raining.

But to get back to this idea of fair, a fair-based approach, we're scared when we don't know. And the reality is there is a lot that we know about this pandemic. And there's a lot we know from past pandemics that we can draw from to prepare ourselves. And again, the main motivation is once you understand how this works, yes, you want to try and limit exposure if you can. But as we've seen with this pandemic, exposure is pretty inevitable for a lot of people, right? and obviously extremes of age, people who have other factors, like people who are immunocompromised or have a condition where they'd be at high risk, they have to take different precautions.

But for most of us who are basically healthy, we're going to get exposed at some point. But illness is not inevitable, even if exposure is. So the outcomes I'm interested in are not preventing you from ever being exposed to a virus, because that's just not reality. And maybe it's not a good idea when we drill down. but what about your outcome? I want to make sure that you don't end up on a ventilator in an ICU dead or with long COVID. I want to make sure you have a full recovery. And while we can't guarantee that for anybody, we know a lot about what some of those factors are that determine the people

who are going to have the poor outcome. So one of the most significant studies that came out of this pandemic and it's been repeated, the studies have come from China, they've come from the U.S. is this idea of microbial predictability, that looking at somebody's microbiome, basically, you know, what's going on with the trillions of bacteria living in and on your body, primarily in your gut, is incredibly predictive. So the main study showed that we can predict outcome ventilator use, ICU death, with 92% accuracy looking primarily at the levels of two bacteria. One, fecalibacterium prosniziai. That's, you know, I try not to be sort of good or bad, black or white. But again, fecalibacterium prosnizia, there's no denying, is a good guy. It's a bacteria that is most prevalent in vegans and plant eaters. And it is protective against a whole host of bad things. Diabetes, cardiac disease, metabolic syndrome, colon cancer, high levels of Fecalibacterininitis, are very much

with a healthy microbiome, and they're also consistent with a better outcome from COVID. So high levels of F. Prozni T.I. You're much likely to do well if you get COVID. High levels of a different bacteria enteroccus Ficalis associated with worse outcomes. But here's the thing, Drew, you can't just go borrow some F. Prozni T.I. from your vegan friend. You have to actually feed the bacteria in your God, and we all have some, right? But if you're trying to increase your population of F. Prosnizzii so that you can thrive in the face of viral threats, you have to eat what F. Presnitiae want to eat. And that comes back to the diet, an indigestible plant fiber and all this stuff. So it is, it's a sophisticated way of looking at things, right, doing microbial analysis. And in the study, they found that looking at these levels of enterococcus fecalis, bad, fecal bacteria and presidzii good, was more accurate than

looking at age, comorbid disease, inflammatory markers like C-reactive protein, etc. It was the most predictive. So that's sort of high-level sophisticated. But when we drill down, we see that the end of the day, it's about what you're feeding your gut microbes. That matters. Just one follow-up question on that. What was the amount of, how were they measuring levels of vegetables or any kind of takeaways

from that of what people were consuming? Well, in that study, they weren't looking at people's diet. diet. That study was just looking at the microbial analysis. Of course, it's been other studies and one of the most important ones is a 2018 study from the American Gut Project. And that study did look at what people were eating. I love that study because it was a global study. It wasn't just looking at, you know, we're looking at white men in Olmstead County and we're making extrapolations from that, like a lot of the studies have done. So the American Gut Project study looked at over 10,000 people globally. And they looked at the microbiome.

in people who were eating 30 or more different plant foods per week versus 10 or fewer. And they found they were vastly different and different in things like levels of fecalibacterium and prosonidiae, et cetera. So what we know is that it's not just eating, you know, a couple servings of vegetables a day, it's also the variety. And that makes sense, right? Yeah, we want, if we want a diverse and robust microbiome, we need to eat a diverse and robust diet. And, you know, when I tell my patients, this because I have this thing with my patients, I call the one, two, three, three rule, one vegetable at breakfast, two at lunch, three at dinner to get to six servings.

But after that study came out, I changed it up. I said, you need to eat six different vegetables or plants. And people think, you know, 30 plants a week, that's a ton. but if you think about a bowl of oatmeal. So you have oats, one, maybe some almond milk, two, raisins three, pumpkin seeds four, walnuts five, blueberries six, maybe throw some shredded coconut in there, seven. That's seven just from a bowl of oatmeal. So it really is just being aware, right, that the variety matters and diversity matters and thinking, okay, I'm eating a salad and it's lettuce and tomato. I'm going to throw in some chickpeas. I'm going to throw in some fermented salary, I'm going to throw in, you know, some carrots and just adding to it. And it doesn't

need to be a lot. We're talking about really small amounts of things, you know, a little handful, a tablespoon. A tablespoon of sauerkraut provides up to 28 different strains of unique bacteria that contribute to your microbiome. That's a tablespoon, 10 grams. So it's just these little consistent things. It's not, you know, nobody has to go off and become a raw vegan, unless they're interested in doing that. There are other reasons to do that. I've probably been a raw vegan for three days at a time and felt great. I was a raw vegan for four years.

Yeah. Yeah. Did you feel like your microbiome was just glowing and booming? Tell me about that. You know, I think that initially, anytime people do anything where they're getting off of processed foods, they're going to feel immediately better. And, you know, you write about a lot of this, you know, even say that there are many vegans, right? And some of your family, ancestry, your father's side, South Asian, you know, my family's South Asian.

I have a lot of South Asian friends that are vegetarian, vegan. The diet is quite filled with processed food. And I have plenty of friends that are plant-based. And they have a ton of that. And I have friends that eat meat and other things like that. It's really, there can be all different sorts of things inside of that. So when I was getting away from a processed vegan diet, which I was on for a few years, immediately I felt like amazing.

Where I started to notice, since just you asked about it, I noticed for me things like quinoa, brown rice, a lot of grains, even trying different gut repair protocols, leaky gut. After a while, I personally removed a lot of those foods out of my diet just because I felt I couldn't handle them digestively. I would feel low energy and things like that. And what did you replace them with? Not a curiosity. I just stuck to, I still always have a ton of vegetables.

Always have a ton of fermented food still to this day. I drink juice. But in that instance, just because you're asking, I filled that in where that was a huge chunk of my diet. And I started including things like fish and some targeted animal protein from only clean sources. So I never stopped eating vegetables. And that's key.

And I never stopped. And I think that, you know, part of what I was asking about, you know, they are just out of my genuine curiosity when you're saying this two bacteria is highly present, you know, for individuals that are vegan, is it the absence of animal protein or is it the inclusion of having a lot of plant food and the diversity of it, as you mentioned? Just because our audience. It's 100% the plants. And I personally, and especially when,

with patients, I don't like to use the labels because what we have seen, now there are other reasons, very good reasons, to decide to not eat animals. There are ethical reasons, there are environmental reasons, et cetera. But I'm a doctor. And so when I'm talking to patients, I'm talking to them from a health point of view. And so I see in my practice patients with very complicated autoimmune diseases like Crohn's disease and ulsterocolitis, celiac disease. And so when I'm talking to them about what they need to do and how they need to eat to put their disease into remission, it's purely through a health lens. And I'll tell you that from a health lens, there is room for other things on the plate besides plants, right?

But you have to have the plants on the plate. So we did a study in 2014 in our patients with inflammatory bowel disease, Crohn's and Ulsterisd colitis. A small study retrospective. and we looked at people who at that time were following something called a specific carbohydrate diet. And the specific carbohydrate diet, which I know you're familiar with, was popularized by Elaine Gottshal in her book Breaking the Vicious Cycle. It's sort of a third cousin of a low-carb diet.

But there are a lot of ways to interpret it. And the reason we decided to look at this was because so many of the patients with Crohn's and colitis were coming to me in the practice already on the diet. They were like, I read the book, I'm on the diet. and they were doing well. So I said, I wouldn't want to see what's going on with this diet. So we looked at about a dozen patients, and we looked at, first of all, the time it took for them from when they started the diet for their symptoms to go into remission. And that was around 30 days. It was about a month, which is pretty quick when you think about these complicated autoimmune diseases.

In my real life experience, it's about 60 days. But in that, in the study we did, it was about 34 days. The other thing we looked at is what was a likelihood that somebody who was using really nutritional therapy of this kind to treat their complex autoimmune disease could get off their medication. And we found seven out of the 12 patients were able to stop or decrease medication. When I did colonoscopy on them, did colonoscopy in eight of those patients? Six out of the eight had complete mucosal healing of their ulceration, the gold standard for remission. But the most important thing we found, Drew, was that there was a direct correlation with the amount of plant fiber they were eating and how well they did. So the people who were interpreting it as sort of a

paleo or a keto diet who were eating bacon and eggs for breakfast and chicken for dinner and steak for lunch with a few broccoli florets, those were not the patients going into de-permission and getting off their medication who had the mucosal healing when I did their colonoscopy. Direct correlation. But, and again, this is just, you know, what I have experienced in my medical practice really treating thousands of these patients, there is room for some animal protein on the plate. You just have to get the plants in. They forgot that the most important carbohydrates is the plant food. That's the carbohydrate you don't want to remove. It is a plant food. And anybody who knows what they're talking about in that space

is going to tell you that this is the carbohydrates you want to keep in your body. Yeah. And, you know, for those patients, removing the processed grains was essential, as you talked about, right? So For most... For some of them, probably they healed a little bit. Exactly. And then they could reintroduce them. Yeah. And it's very variable because that's the other point you make that I'd like to emphasize

is it's very personalized. What works for one person isn't necessarily going to work for another. So, you know, following a protocol or someone's book, whether it's, you know, a whole 30 or specific carbohydrate diet or maybe it's even a raw vegan diet is a good place to start, but that may not be where you end up. And it's important to, you know, to be open to the idea that, you know, this work for your friend or for a thousand other patients, but maybe it's not working for you. And to really have that internal dialogue with your body about what's working. Just because we're on the subject and people

love to hear from the expert, which is you, about their own journey. Was there ever, is there anything in your recent history that, you know, you thought was working for you for a long time, but you switched a little bit just because you were listening to your body and you kind of took it in a different direction. Anything that comes to mind? Yeah, you know, there've been a couple things, both on the exercise and the food, the exercise in food realms. And you can talk about anything you want. Yeah, yeah, yeah, sure. It could be lifestyle.

It could be whatever. Yeah. So I'm a runner. And then I'll qualify that and say I'm a slow runner. But I've done, you know, half a dozen marathons. I've not broken any records, that's for sure. I said never even cracked four hours on the marathon. But I've been running marathons for a long time.

And running always makes me feel good. Not necessarily when I start or even during, but always at the end. And lately, I found that running, it's just. sort of not the same. And actually, I've been lifting heavy weights and really enjoying that, right? And feeling like really strong from that in a way that running hasn't made me feel strong in the same way. And it just feels better for my body. And I notice that when I'm doing things, like, I'm like, wow, I can do this. I'm strong from from lifting weights. With the food, I just found that eating less food is feeling better for me now. So I don't follow any particular intermittent fasting method for about, four or five years I did. So I did 24-hour fast on Monday and Thursdays. And I picked those days because they were my busiest days at work. So it started out sort of as an accident, right? I was just

really busy on Mondays seeing patients all day, Thursdays in the hospital doing colonoscopies all day. And so what I started doing was I would have big meal on Sunday night. That's typically a family dinner. My sister lives in D.C. My parents are there. We usually all gather with our families and have a really nice meal on Sunday night. And then I wouldn't eat again on. until Monday night. So I would, you know, have Monday, go to work, be busy. And then the reason I started doing it, again, was I was just busy. But then I found that I had more energy from really not eating during the day. And I would break my fast on a Monday pretty early. Like I'd get home from work, six o'clock. I'd head straight in. I'd have the food prepared, everything ready to go. It's pretty

hungry. I remember having to go to a back-to-school night on Monday night. I didn't get home till 9 o'clock. I was hangary. I was like, this is too long. So I did that Sunday night to Monday night and Wednesday night to Thursday night. And it just felt good. Again, I had more energy. The other thing was I felt really grateful for the food when I had it in a way that we don't always feel, right? Food is plentiful for most of us, not for all of us in America, but food is plentiful. It's readily available, et cetera.

And you can kind of just go from one meal to the next. You're not really thinking about it. So when I got to dinner, I was really thinking about it. I was really ready and grateful. So on a sort of spiritual level, it just felt like it's good to have a little bit of sacrifice and then to have this, you know, wonderful breaking of the fast and to appreciate it. And honestly, I did it all the way up to pandemic. Then pandemic hit and everything was all, you know, turned around and there was no schedule. And I stopped doing it. Yeah. So I do miss that. And I sort of got into like a three meal a day thing, which for me just feels like too much for my body.

I don't need to eat three meals and I feel better when I eat, you know, maybe a little something in the morning and then a big meal in the middle of the day, which has been a little bit easier to do with pandemic because I'm home a lot more and then something light at dinner. So again, just having that conversation, that dialogue, and I'm never dogmatic about it. You know, if I'm super hungry, I'm going to eat. It's never like, oh, you know, it's not 6 o'clock. You can't eat yet. But just intuitively, by doing that, I found that like eating this large meal in the middle of the day

feels really good and not eating a lot at night feels better. Yeah, I love that. Thank you for sharing that, by the way. I think people love to hear about personal experimentation, how it changes over a period of time. And the idea of staying open, listening to your body, you know, use the word sacrifice. And Reverend Michael Beckwith, who's a friend

and been on this podcast before, he was saying, you know, the origin of the word sacrifice is to make something sacred. And so this idea, if there's constantly overstimulation around us, that could be in the form of media, TV, It could be in the form of, you know, having too much, you know, sugar in our life or, you know, food or whatever. And taking a little bit of a break, fasting, you know, we can fast from the news sometimes. We can fast from, you know, over, you know, taking in too much information.

Fasting is a way to make things sacred. We're making, you know, you were saying like how special food was to you and how much more you enjoyed that process. And I just love that connection. Right. I'm going to take a little bit of a turn here. Okay. Back to planned food and expanding on that a little bit more, you know, one of the stars of your book that you write about pretty early on in the chapters is you talk about short chain fatty acids,

right? So what are short chain fatty acids and what role do they play when it comes to the strength of our inner terrain? Yeah, short chain fatty acids are really gut superheroes. And what they are is they are post-metabolical. the light. So let me just take a minute and talk about this whole sort of prebiotic, probiotic, probiotic. A prebiotic. So when we talk about biotics generally, we're talking about bacteria, whether ones that you are buying from the health food store and ingesting or ones that are

already in your gut. So a prebiotic is the food that feeds a healthy gut bacteria in your body. And those are foods that are typically fibrous foods. So it's a wide array of prebiotics, but it would typically be things with a lot of fiber, but oats are also prebiotic dandelion greens, all kinds of different prebiotic foods. Probiotics are the live bacteria themselves. Again, the ones in your gut as well as the ones that you might consume. And then postbiotics are the metabolites of what the bacteria are doing. So when it comes to short chain fatty acids, we're talking about bacteria that are fermenting

primarily indigestible plant fiber, poorly digestible plant fiber, fibrous, foods. And in that process of fermentation, they're making short-chain fatty acids. And some of the ones you might have heard about are butyric acid or buturate, propionic acid, or propriate, and there's several others. The reason short-chain fatty acids are so important, two main reasons, and both these reasons harken back to protecting us from viruses. The first is the gut lining, the intestinal lining. So the lining of the gut is permeable. It's like a fishing net, and it has tiny little holes in it. And it's designed for certain things, to be able to go through and the waste from cells to be excreted out.

Because, Drew, remember, when something's in your GI tract, it's not actually in your body. It's in this long tunnel that goes from your mouth to your anus, but it sort of bisects your body, right? It's the outside world. It's the outside world. And so this intestinal lining is this permeable net to, and it's a highly selective barrier to decide what gets in and what comes out. we can have holes in that net, and that's called increased intestinal permeability.

Some people know it as leaky gut. We're essentially talking about the same thing. And there are lots of things that can damage in it. So non-steroidal anti-inflammatory drugs, nseds, things that have ibuprofen in it are one of the things that can do it, too many antibiotics, infection. There's all kinds of things that can do it. And short-chain fatty acids are intimately involved in the health and integrity of that gut lining, keeping it nice and tight so that toxins, poorly digested food particles, and viruses

are not able to penetrate that gut membrane, get into your bloodstream, travel to the rest of your body, and wreak havoc. So that's one really important function of short chain fatty acids, is keeping those intestinal cells in the lining really happy and healthy. Another big function is with the immune system. So I'd like to talk about this Goldilocks immune system. One of the really sort of incredible things about viruses like SARS-CoV-2 is that it's our immune response to them that often does us in, right? That can make us really sick and even kill us. It's not the virus itself. It's an overblown immune response. What we've come to know is cytokine storm, what we've heard on the news, and some people have a very imbalanced immune response. And so for all of us, we want to have an

immune response that's robust enough to clear the virus, but not so overwhelming. that it damages normal tissue and leads to damage to lung tissue, heart tissue, et cetera. And that this is this very exaggerated immune response. Cytokine storm is another way of another term for it. And what we also see is that people who don't have high enough levels of short chain fatty acids are at risk for having this overblown immune response. We've seen it in mice. We've seen it in humans.

It's a very clear correlation between the levels of short chain fatty acids. So again, this is sort of a very very very. very high-level sophisticated idea, right, that the short-chain fatty acids guide the immune system. But when we drill down just a couple feet, we see, okay, how do you get high levels of short-chain fatty acids? You've got to eat a lot of plant fiber. So there's just really no way to get. And, you know, Drew, sometimes with patients in my office with these complex problems, I'm sitting there thinking, how can I make eat more plants sound really sexy and medically complex, right? But at the end of the day, that is a key element of this.

It's not the only thing. And there are other high-level sophisticated medical things. But that is a foundational aspect of how we maintain a healthy gut, a strong immune system, and intact gut lining is that we eat more indigestible plant fiber so that our bacteria can ferment the fiber, produce a short chain fatty acids. We can have a Goldilocks immune system. So off that topic, you know, a lot of people that start to. get into the space and they're removing processed foods and they're trying to tweak their diet. Some

people go through this period of time and you've written an entire book on this where they're just noticing that they're eating more foods. They're trying to include the diversity and they're experiencing bloating. So what's often going on in those instances? Because I know you have a deep expertise in this. Yeah. I wrote a book about bloating. The bloat cure. Yeah. Bloading is one of those things that there's so many different things that cause it, as you said. And anatomical. If we look at the GI tract, in textbooks, it's drawn as its nice gentle horseshoe, right? But it looks much more like a slinky. They're all kinds of switchbacks and sharp turns and so on.

And one of the things that can happen when you really rev up your dietary fiber is that things just get stuck in these sharp turns and people get bloated. And then they think, oh, I'm having a reaction. I'm intolerant. This is bad. Not bad. Not bad. One of the ways you get around that is by drinking more water because at the end of the

day, there is an element of just plumbing to this, right? It's this long tube. It gets clogged. How do you clear a clog pipe? Drink some water. Not that mine are particularly clogged right now, but so again, sometimes what's happening with a fiber is, and some types of soluble fiber will absorb a lot of water and create almost like a gel-like mass in the intestine. And again, this is a very healthy phenomenon in the intestine. But if you have a very curvy colon in my female patients, I like to call it the voluptuous venous colon. And that's to counteract what has, it's been known as for decades, which is in the GI world, we've often said it's a tortuous colon or a redundant colon. Nobody wants to be told their colon is tortuous or redundant. So voluptuous venousin

colonized colon, sounds better. But, you know, I do a lot of colonoscopy in woman, because a lot of my patients are female, not all, but many. And colonoscopy in woman is much more challenging because they have this much twistier, curvier colon. And that's because, as well, woman, we have longer colones. It's on average about six centimeters longer, which doesn't sound like a lot, but it can create a lot more twists and turns. We also have a lot more hardware down in our pelvis. We have our reproductive organs. We have the fallopian tubes, the uterus, the ovaries. And so our colon has to wrap around all of these organs. And then finally, we have lower testosterone levels, which means our abdominal wall, even if we're, you know, doing lots of sit-ups. Our abdominal wall is not as

tight and doesn't hold it all in as well. So for this reason, women have this voluptuous venous colon much more likely to bloat. It can happen in men too, but more common in woman. And so I really, you know, there's so many things that people can do when they're having that. And I really want people to not just say, okay, well, fiber is bad. I'm having a bad reaction. But to think about how much water are you drinking, how much fiber are you eating at one sitting? Do you maybe need to split up that meal into two or three smaller meals? What time of day are you having? You have a having the fiber. If you're having a lot of fiber later in the day, that's when your GI tract is less active and you might not tolerate it as well. And that's particularly true if you're taking a

fiber supplement, like Cillium husk or acacia fiber, which a lot of my patients do. Might want to take that earlier in the morning when the GI tract is more active. So are you constipated? You know, is a fiber sitting on top of a big column of stool that's not moving out and that's why you're bloated? So they're mechanical issues, there are physiological issues. There's some hormonal issues that are involved that can really all combine to either make the fiber go through quickly or slow things down. And that's a little plug for my first book, Gut Bliss, that or the third book, The Bloke Cure, both of those, you'll find some good tips there if you're having trouble tolerating fiber. Some of the things you can do, for example, if you're having a lot of

bloating and gas with beans, would be soaking the beans ahead of time, cooking them with a sea vegetable using an enzyme like beino alpha one galacticidicidase that helps to break down the raffinousin beans. So there are lots of things you could do. And just eliminating these foods is really low on the list for things that you should be doing. There's lots of workarounds. Yeah. I love when I go visit my mom because she always is cooking her beans and lentils in a pressure cooker. You know, that's kind of like the, that's a big part of like the, I'm not saying Indian tradition that we were doing it like long time ago. We were probably doing slow cooking. Yeah. Right. We're probably doing slow cooking, and that was one of the ways that we, you know, got around all this stuff.

But whenever I crave a little bit of lentils or whatever, I know I'm going to have my mom's food and it's not going to make me blow it at all. Okay, let's come back to viruses. And I think that, you know, we've been talking about the pandemic. But another important part about this is that, you know, largely I think the public is kind of ready to be back to normal and the pandemic is behind them, especially in the health podcast. people talked about the pandemic so much and boosting your immune system. But I really want to help people understand that everything that you're talking about here is not just about COVID. It's also about just for people who get sick quite often, right?

So one of the fascinating things that I learned from your book is that there's a lot of people that deal with a lot of mucus buildup. And they often think of mucus as something that's coming from the head region. Like, I'm just so stuffy. And then they'll go take some sort of, you know, medicine to just, quickly get rid of the mucus. Help us understand a little bit more about mucus and why you wrote about it inside of your book. I'm so glad you mentioned mucus. First of all, mucus is primarily made in the gut, about one and a half liters a day. So a lot of people, as you said, think it comes from

the head or it comes from the lungs, but it's made in the gut. And mucus is like a cross between jello and glue. It's a sticky matrix and it's designed to ensnare things, pollen and toxin, smoke, but also viruses. So mucus traps viruses in this sticky matrix and then the cilia, the finger-like projections in your lung, help move it up so you can cough it out or spit it out or swallow it. And swallowing it is fine too if you have stomach acid. So when you swallow the mucus with a virus trapped in it, that's when the stomach acid denatures a viral protein. So you're sort of getting double protection there. Mucous also has proteins in it that can dissolve enzymes and proteins that can dissolve viruses. So one of the things you don't want to do is dry up your

mucus or get rid of it if you are struggling with something. And we know that, you know, the American Academy of Pediatrics, for example, recommends not using cough suppressants in kids when they're sick. Well, the same goes for young adults too, right? And older adults suppressing these reflexes when you get a lot of mucus production and then you cough stuff out or you spit it out, it's your body's way of expelling the virus. And so these are some of the things that, you know, we think of these things as nuisances, stomach acid, mucus. And again, reframing the way we see these things. These things are designed to protect you. They're not an accident. The really interesting thing about mucus too is when we look at super spreader events and we know with Ebola, with SARS-CoV-2,

even with measles, it's generally a small percentage of people who are responsible for a lot of the transmission. So if you get coughed on by somebody, for example, whose mucus is really potent, the musins, the proteins in their mucus is really good at denaturing, dismantling the virus, and they're infected and they cough on you, you're much less likely to get it, right? Because their mucus has done its job. But if you get coughed on by somebody who's a super spreader whose musins, a protein in their mucus may not be as good, or their mucus is thinner and just not as good, you're more likely to get it. So when we look at the proteins in mucus, we have super spreaders and we have super recipients too. So you get coughed on by somebody. Their mucus

didn't kill the virus. And your mucus isn't killing it either. And again, there are things that, so beyond just not taking a cough suppressant and letting the mucus flow and do its job, there are other things you can do too. So smoking, we know, really degrades the nature of mucus. You want to be well hydrated because we want the mucus to not be so thick. that it can't do its job. And so hydration is really important for creating more fluid mucus, air quality. So again, diet, nasal breathing, diet, all of these things make a huge difference. Yeah, you asked me early about changes. That's one of the other things I'm trying to do is when I run slowly and less than I used to is breathe through my nose in and out instead of my mouth.

I read that fantastic book, Breathe. Yep, by James Nestor. Yeah, that was terrific. And it's really made a difference. Yeah, no, absolutely. We've had also Dr. Lou Ignaro, Nobel Prize winner on the podcast, and we had James Nestor on the podcast too, both huge proponents of nitric oxide production. Yes. And how that also is crucial in the destruction of viruses. You know, try to catch it up here as much as you can, whatever you don't end up catching, you know, your stomach acids play a big role as you've been sharing with us. It all goes in together. And it's just another reminder that, you know, people who get sick often, it's not that you're getting sick as an absence of Tylenol or you're not getting sick because of your absence of cough syrup or that.

You know, our body was designed to be this incredible, intricate system. And often the things that plague it are more of a byproduct of not the right environment being created rather than the absence of something externally that we, by the way, have had access to for our evolution of hundreds of thousands of years. Or we're sabotaging something. I'm glad you mentioned Tylenol. This is another really interesting fact. Yeah, you have a whole section of the book on fevers. Let's talk about it. Fever. Poliovirus replicates 250 times faster at normal body temperature compared to when you have a fever. Your fever is your body's way of slowing down, in fact, halting viral replication. And what do we do when we're sick and we have a fever?

we reach for the Tylenol or the aspirin, the motrin, right. And of course, there are times when those things are either necessary or can be helpful. And one of the things in this book is there's a huge section at the back of like, okay, what to do, right? Don't just tell me what I shouldn't be doing. Tell me what I can do instead. And there are guidelines for babies, for infants, for adults, for when a fever needs medical attention versus when you can safely ignore it. And what else you can do to make yourself comfortable, right? Like a lukewarm bath or drinking something cold. etc beyond just reaching for the Tylenol. But so many of these things, you know, it's this, it's this idea of these positive and negative feedback loops. So I use the example in the book of

a hangover, right? Thank goodness for hangovers. People would die of alcohol poisoning. If you could just drink alcohol all night long, you didn't feel crummy in the morning. I mean, a lot of people would not wake up in all seriousness. So a hangover is your body's way of putting the brakes on something that when it gets to a certain point is harmful. and can kill you. Muscle aches. If you've sort of been a couch potato and then you go out and you decide to run 20 miles, you're going to be sore the next day, right? That's your body's way of saying you need to go a little bit slower with that. Even acid reflux, if you're chowing down on a cheeseburger or porta house or having a couple scotches at midnight, you're going to have pretty heartburn,

even if you don't normally have acid reflux because your stomach is not going to be able to digest all that food late at night. You're overfilling your stomach. The acid is going to come up. So so many of these things that we perceive as inconvenient or nuisances are designed to help us stay healthy and to protect us. And so again, it's this way of looking at how the body works and understanding. And not to say that, you know, you just have to suffer because I think that's what people in my family would say, like, well, Robin just wants, you know, just suck it up. not at all. There's so many other things you can do, but it's really understanding this process hair that's going on, whether it's a fever, you're producing a lot of mucus, you're having acid reflux,

what is your body trying to tell you? And what should the appropriate response be? And, you know, again, with this whole message of fear and should be afraid and so on, the thing that if you ask me, Drew, what's the one thing that you want people to take away from this book? it is this idea that host health matters. And in fact, the health of the host, us, may matter more than the potency of the pathogen. And we see that if we look at something like Ebola, which is a bad player. Ebola is only able to infect about one in every three adults it comes into contact with and a tiny percentage of children. Poliovirus, something's old that maybe knew again, that we're, you know, we're kind of seeing with these reports of polio and the sewage of wastewater in New York.

But if you look at polio virus, in 0.5% of people, polio virus crosses through the intestinal lining, gets into the bloodstream, travels to the central nervous system, and causes devastating paralysis. But what about the other 99.5%? Why not in them? In HIV, 10% percent, of people of European ancestor who get exposed to HIV will never get infected. We see for things, you know, common sexually transmitted diseases, when we look at herpes and human papillomavirus and even HIV, we know that depending on the complement of lactobacillus bacteria in your vagina, if you're a woman, you can be incredibly resistant to these viruses. I mean, you still want to practice safe sex for sure. You don't want to rely on your lactobacillus bacteria to keep you safe. But we

know that women who have bacterial vaginosis, a condition where they have low levels of lactopacillus and a lot of those acid-producing lactobacillus that repel viruses are replaced by other species, they have much higher rates of getting HIV, HPV, HSV, etc, when they're exposed to these viruses. So again, this is not an accident. Host health matters. It matters greatly. And really, that's what this book is all about. How can we be healthier hosts? How can we optimize and utilize those incredible innate host defenses, most of which are located in our gut, so that we can be healthier. No, it's such an important reminder. And I think a lot of people who are listening to this podcast, who are regular listeners of mine, and probably a lot of people in your community, too,

they felt that at a period of time, you know, and this is just the world growing up, you can have, you can practice duality. You can say, again, all these public health measures are important and we can go into the nuances of them. But a lot of the, little bit of the sentiment was how dare you say host health matters because it's taking away attention from everything else. And I think that part of what people are really understanding now is that you can have both. And in fact, it's so important because in the instance of what we just experienced and there'll probably be a future pandemic, especially, you know, depending on how much people have looked into gain of function research or not and how much that played a role

or not, you know, that could be a possibility is that the stronger you make yourself, the better protected you are, regardless of everything else that's going on. Absolutely. And I want to follow up on both of those things you said because they're both incredibly important. The first is a duality. And I actually did a little post one day on Instagram that was taken down from violating the community guidelines. And I was shocked. I'm like, I am all in for vaccines and public health guidelines. And this post basically said host health matters in addition to the other things you can do. And I talked about, I gave the same statistics I gave you about Ebola and polio, etc.

And said host health matters, you know, in addition to all the other things in our medical toolbox, I was shocked. I was like, that's crazy, right? To actually say, I mean, when you think about it with anything else, if you're an 85-year-old who smoked your whole life and been sedentary and overweight and diabetic and hypertensive and you get pneumonia, you're going to do worse than if you're a 25-year-old healthy marathon runner, right? That's just with everything, with cancer, with viral illnesses, with heart disease, with every kind of unfortunate thing that can happen to us, the healthier you are,

the better your outcome is a likelihood, right? And so it is vitally important that we don't neglect that part of the equation. and that we embrace the fact that we can talk about host health mattering in the same breath that we talk about vaccines and monoclonal antibodies and all the other incredible things we have at our disposal in the medical community. And we can also make the point that we need to use these things judiciously. Yeah, absolutely. And I think this is a larger conversation that our society's going through right now. It's really the idea of not fearing personal responsibility. Because the Law of responsibility says that if you had some part in it, didn't mean that you caused it.

It doesn't mean that there aren't socioeconomic factors that are involved. Doesn't mean that you were not born in the wrong zip code, which gave you less access to health care. It doesn't mean that. It just means that if you play a part in it, that's a good thing because that means you can be part of the solution. If you're part of the problem, you're part of the solution. Instead, if we're all victims and obesity just happens to us so you can't.

can't tell people the importance of losing weight and also helping understand that, yes, okay, the food industry has hijacked health in certain ways. You know, yes, we've been lied to and told that sugar wasn't a problem in terms of driving fat and our obesity epidemic that's there. So there are definitely different components that are there. But if you can't advocate personal responsibility, you actually can't advocate for people to solve their problems. A hundred percent.

You take people's power away. And but the other thing that happens is then you also leave people with the only option as a medical option, right? So there's a lot of commerce involved in that too. It is the most empowering message idea that, and I go, I experience this with my patients with inflammatory bowel disease all the time. I tell them, this is not your fault that this happened. But here's some things that you can do to make it unhappen.

So it is an incredibly empowering way of looking at health. But you're right, is that it's turned into this like, oh, you're blaming the victim. kind of thing, right? I mean, I have this discussion all the time. Obesity is a medical disorder that is associated with a dramatically increased risk of dying and being sick. And when we look at COVID, we know that obesity, having obesity, is one of the major risk factors, particularly in younger people, for death. And so that's something we have to talk about. We have to talk about the fact that ventilation is affected in people who have obesity, that they have clotting flotting factors floating around that make them more likely to have blood clots and to succumb to

something like that. We have to talk about the fact that adipose tissue is immunologically active and not in a good way. So it affects the immune response. These are all medical factors that we have to consider. And, you know, Drew, what is the biggest factor for people who have obesity in terms of contributing to their likelihood to do poorly is the saddest one. It's the stigma associated with having obesity that often prevents them from seeking out health care early, which is so tragic, right? So is there a way to destigmatize it, but at the same time, acknowledge that this is a medical condition, it's a dangerous medical condition, and here are some things that you can do, and here are some tools that we can provide that can

help you overcome this. Yeah, and just like you did in your book is also helping them, which is not always in the best interest of, you know, traditional media is helping them understand how they've been lied to, how their health has been hijacked. And often it's from well-intentioned people. It's not a vast conspiracy theory. It's just commerce, right? People are looking for economic gain, so they want to tell you what's better off. And so when you can help take them on that educational journey, which is required, then they can understand like, wow, Wow, you're both telling me this duality of I was part of the problem. Wow, that's empowering.

That's not a bad thing, by the way. Nobody's shaming you. Nobody's blaming you. But yes, there's a responsibility that's there. And by the way, you didn't cause this. Right. So the blame is not on you. So you didn't cause this.

And that is like the best place to have somebody be because they understand that there's this greater system that they fell into that created the conditions. And anybody who fell into that condition would have ended up with the same result. But because they were part of that, now we can steer them in a different direction. Sorry, you're about to say something? Well, I was about to say in your earlier comment, there was something I wanted to follow up on, which was this important point you made about, yes, we all have pandemic fatigue, but this is not a want-and-done. And one of the things I feel very strongly about is none of my books are designed to scare people. They're all very empowering. This is all like, this is challenging, but here's what you can do. It's all about here's what you can do. But I do want to point out the numbers. Please. In the last 50 years, we have had more than 30 viruses for which there is no cure. Serious viruses, things like HIV, Ebola, SARS-CoV-2, and more are coming.

So how more are coming and how do we know? Well, a 2021 study from Duke looked at statistically the likelihood of a pandemic like COVID-19 happening in our lifetime. And they calculated that the risk is about 2% per year, which means, that for somebody born in 2000, there was a 40% chance of this happening, right? 2% per year. You're born in 2000 by 2020? There's a 40% chance of this happening.

So these things are not as rare and unusual as we think. And we can, you know, there's a whole separate show about why this happened, right? And what we can do and how we need to live differently as a society in terms of our encroachment on natural habitats, et cetera, to prevent stuff like this from happening. But it's happening because that genie is not going back in the box in terms of when you look at not just our society, but others, populations are growing, cities are growing, we are capturing land that was previously where wild animals lived and so on and humans are encroaching much, much more on that.

And that's only something that's getting bigger as a population grows. And that will lead to more situations like this. So, you know, while we all sort of were like, my goodness, I can't believe this is how We should have been saying, my goodness, I can't believe it actually took so long to happen. And what can we do to make sure this doesn't happen again and or how can we be more prepared for it? It's maybe too hot of a subject to touch. But just because you're here and I'm asking you and you're talking about future one.

Put me on the hot seat. Why don't you? Is there any sort of feeling that amongst all those things that you mentioned, encroachment, natural habitats, et cetera, maybe the eating of rare animals, et cetera, that sort of thing, in your view and research, and right now there's a virus that's had a couple outbreaks in India called the NEPA virus that is way more deadly than even COVID-19. And is your any concern about some of the world of gain of function research? And do you know much about it at all? And if you want to say skip, we'll skip and I have a couple other questions.

It's not my area of expertise for sure. so I'm commentating sort of, you know, armchair observer, but I obviously have done a lot of research into it in the process of writing this book. And there's not one single factor, but the encroachment is a huge one. The encroachment is a huge one. Okay.

The encroachment into the animal's habitat. You know, people, I live in Rock Creek, I live in Washington, D.C., right on the edge of Rock Creek Park, and they're there everywhere. And in our neighborhood, I literally, like, look out my window and there's a park. It's a beautiful setting. And people and neighbors complain about the dare, I'm like, we're in their hood.

How are you complaining about the deer? This is a forest. You're a guest. You know, we have to look at it differently. And I'm glad you brought up this idea of animals and wildlife and so on because it's not just what we eat. We spent a lot of time talking about food and fiber and short chain fatty acids. But the environment is also hugely important.

So there's this concept called the open air factor. I know you're familiar with this, this idea of an environment being helpful. And if we look at the Spanish flu epidemic a century ago and we sort of draw some conclusions from that, one of the things that we saw is that people who recovered outside in the open air did much better. And we know a lot of this from the military numbers. So the enlisted soldiers were typically put in cots outside the hospital because they weren't enough beds.

And the officers were in the hospital. But the officers did worse. So mortality rates for recuperating inside the hospital were as high as 40% in some areas and 13% for those recuperating outside. And the open air factor, the OAF, is defined as this germicidal constituent in open air that somehow can help control and kill viruses and also certain types of pathogenic bacteria. And it's very real. It is not, you know, a woo, whoa, go outside in nature.

this is something that we have statistics behind. We know that things like forest bathing can decrease blood pressure, can improve heart disease, can improve feelings of well-being, and can make you more resilient. Exposure to soil microbes. We know that rurality, people who live in areas where they're exposed to soil microbes and animals and so on, have additional immune resources to defend them. So these are all things we have to pay attention to it. This can be tricky, right?

because we're being told to quarantine and socially distance and isolate at different times during this pandemic. But there's simple things, and a lot of them are in the book, like literally going outside, opening a window, even opening your car window when you're driving, how you can take advantage of some of these factors to improve your resilience. It's an important message, and I think that it's a reminder that so much of what we think of as disease, so much of what we think of as sickness is a survival mechanism. It's our body just doing its best to adapt. And if we can see it, and as you said earlier, what is your body trying to tell you? If we can try to read the messages, which of course takes guidance from individuals like yourself who are

out there, you know, helping people understand and make that connection. I love the section on fevers, by the way, because even with kids, one of the things that you share for young kids was, and I have nephews and nieces and other stuff is that so many people are, and you know, fevers, high temperatures for babies is very, you know, can be very risky and can lead to other complications. But you wanted this whole thing where you were sharing that the seizures that often people are worried about. Actually, do you mind talking about it a little bit? Yeah, not at all. Not at all. Yeah, so febrile seizures are one of these things, you know, and actually our daughter, who's now 17, when she was a baby, she was sick a lot and would get these super high temperatures 104.

And it's really scary. I mean, you have a small child. They're literally hot to the touch and they're screaming and you're like, ah, you know, want to do something. Babies don't sweat as much so they can't cool himself down. Yeah, yeah. But first of all, febrile seizures are almost always benign and self-limited and you have one or two. I mean, anybody who's dealing with this obviously should be seeking help from their health care professional. Dr. pediatrician the whole deal. Exactly. But there are some guidelines in there that are taken directly from the pediatric guidelines about when to treat, when not, and looking at other factors too, like, is your child, do they have a fever, but they're happy and they're eating and they're

engaging, making eye contact versus do they have a fever and they're listless? And in fact, at an even lower temperature, if your child seems very listless and not making eye contact, especially with a small baby where you can't ask them, that's more worrisome than just a high fever, right? So there are other things to look at. Right. High temperature alone should not be the only factor. Exactly. The other things to look at. And when do you call the pediatrician and what can you do, et cetera? and what are other ways to bring down the fever. But, you know, we've been using fever therapy for centuries.

In fact, Hippocrates famously said, give me a fever and I can cure anything. So Hippocrates said a lot of great things, including all disease begins in the gut. And another one of my favorites, which is one of the ones that opens a book, which is it's more important to know what sort of person has a disease than what sort of disease a person has, right? Yeah, I like that. But I want people to not be afraid. One of the things that I love about being a doctor, and I come from a little bit of a family doctors. My dad's a retired orthopedic surgeon.

My brother's an orthopedic surgeon. Also, I had to leave the orthopedic area because it didn't really appeal to me. But I love being a doctor for what I know and how I can reassure my friends, my family, my patients that, look, this is your body doing its thing to protect you. Don't be scared by this. And you don't have to have this knee-jerk response of like, I have a fever. I have to take a pill. Sometimes you do. But understand again, why is this happening? And really, it's not the fever we should be concerned about. It's the underlying thing, right? Your fever is both

therapeutic and it's a signal. It's a signal that there's something going on that your body's trying to deal with. And it's also a way of your body dealing with it, like with what I told you about poliovirus, right? It's a way of the body stopping vial replication. There's studies in mice where they see that a fever can slow down the process of acute respiratory distress syndrome. And so when we look at older people, they often, just like they don't mount as strong an immune response because the immune system is waxing, is waning rather, just get the waxing and waning confused with the moon. It's dimming. We also know that they often don't mount as strong a response in terms of a febrile response. And so thermal therapy is one of the things

that's being investigated for cancer, for how fever can cancer. cancer cells and for how it could potentially help with acute respiratory distress syndrome in the elderly. So, you know, we may be seeing future therapies where we're actually inducing fevers in people. There's a few clinics right now that are in Germany. There's a gentleman named Ralph Maas. He was previously at Sloan Kettering, PhD researcher into sort of everything that works and doesn't work for all these different cancers that are out there. Really great website, cancer decisions. And one of the things that he highlights in his work is all these German and European clinics that are using thermal therapy to help treat cancer. Yeah.

And it's just fascinating. You know, it's early. It's more pervasive over there than it is over here. But even in Mexico in a few places that there are some forward thinking clinics, again, this is all super just new. So I'm not telling people to go investigate it, but just to know that it's out there could be a signal of what's to come that they're using thermal therapy when it comes to treating. Lyme disease and the role of that. So it's just fascinating to see that so many of these things that we thought that were bad at one time.

And that's the nature. That's our evolution as human beings is to realize we thought this was bad. It turns out that there's much more to the story. Let's understand it in a holistic way so we can actually apply it into our life. This has been a fascinating conversation. Any subjects that you feel that we didn't get a chance to touch on that you want to share at all before we go into how people can keep in touch with you, pick up the board. book. You did such a great job covering all the different things. I do, there's a, the last chapter of the book

is about long COVID, post-viral syndromes. And that's something. And the first thing I want to tell anybody out there who might be struggling with long COVID is, I'm sorry this is happening to you. That, that sucks. But I also want to remind people that we have a lot of experience with post-viral syndromes and chronic viral syndromes. So you look at something like AIDS. It's a chronic viral syndrome. Hepatitis C that can turn into cirrhosis and even liver cancer. mono-epstein-Barr virus that we now know is implicated in conditions like chronic fatigue syndrome and maybe even MS, as the new data shows, is a post-firal syndrome. So post-viral syndromes are not new and they're not unexpected.

And so there is a lot that we can do. I think the problem was we said, oh, COVID-19, it's like a bad flu, and we didn't expect a post-viral syndrome from the flu, right? Although that can happen too in various forms. So it was our expectation. But if we had said, hmm, we have chronic herpes and we have chronic hepatitis and we have chronic HIV and we have all these other, we have chronic EBV. Maybe this has a chronic phase two.

I think we would have been caught a little less off guard with the long COVID. And we have a lot of data now that has accrued in the last couple years about what's going on with issues around autoimmunity and what's going on on a vascular level, what's going on from the gut flora level and not to sort of bring everything back to the gut, but I am a gastroenterologist. If we look at chronic fatigue syndrome, what we see is that the microbiome in people with chronic fatigue syndrome is very different. And we can predict it. We can diagnose it. There have been some really fascinating studies from Cornell and others where they look at, they can predict, they can diagnose it looking at the microbiome and say, oh yeah, based on this complement of bacteria and what's going on

the different species, et cetera, this person probably has chronic fatigue syndrome. They've been able to diagnose that with high sensitivity. And we also see with long COVID and other post-viral syndromes, but long COVID specifically, there's also microbial signature, if you will. So approaching it from a gut-based approach makes sense, right? It's not the only approach. There are other things going on from an angiogenesis point of view and with autoimmunity and so on. So I'm not in any way suggesting that looking at what's going on in the gut. gut, trying to modulate what's going on, the gut is the only approach. But keep in mind that I'm really talking here about eating more vegetables and increasing plant fiber. So nothing that I'm

recommending is dangerous in any way and will do anything other than generally enhance your health and maybe improve your symptoms, right? So you don't have a lot to lose hair. It's not, you know, these are not like, oh, let's use immunosuppressive medications. Those drugs may have a role in some people in different circumstances, but a lot of what the research, points to is that by modifying what's going on with the gut flora, you can improve a lot of these changes. Yeah. And I think for a while, there was also this sort of debate, I mean, amongst people trying to say that was long COVID a thing, was it not a thing? And a lot of people in the community had to feel like they had to advocate for themselves. And some of the people in a more traditional

lens were like, well, I believe on the latest statistics is that long COVID is heavily gender-based, It was like 70, 80% woman, woman. But when you understand the autoimmune component, even if people don't have traditional markers, and it's a little bit of what you write about inside the book, is that even if you're not fully have the traditional markers, you could have these increased antibody, it almost looks like a pre-automune disease. Well, we know that those, we know that already diagnosed autoimmune conditions heavily are, you know, more women are diagnosed with autoimmune conditions than men, especially when you get more specific

in some of them like Hashimoto's, et cetera. So we're still unraveling a lot of these different things. And I feel like I love that section that you had in the book because it brought so many layers and it kind of connected the dots for a lot of different things that I'd been thinking about. And again, it brought it back to, okay, we may not have all the answers, but at least what do we know controls part, what do we know majorly controls part of the terrain and the soil? And that's our gut microbiome. Our gut microbiome is going to help keep a lot of other things in check. It may not be the full situation for everyone, but it's definitely not going to hurt for you to improve that in your life. And it's likely a big part of the equation. The patient I use in the example in the beginning of that

chapter, that last chapter, long COVID, is a really good friend. And she also happened to be somebody who was an early reader of the book. So before I gave her the manuscript, I had to say, oh, and by the way, you may recognize a lot of the patients. And I mean, she's pretty well disguised and I also got her permission. But it was incredible. So that patient story is the least disguised. I mean, everything in there about her hair loss and the positive A&A and et cetera. And exercise tolerance is absolutely true. And I'm happy to give a little update on that and say she's like 99% back to normal. That's amazing. I'm happy for her. I'm happy that she has. you in her life. And I'm happy that our listeners now have a chance to hear from you directly.

The book is called The Anti-Viral Gut. It's out on November 1st. People can pre-order now because I think our interview will be out a little bit before that. Where can people go to keep in touch with you and anything that you want to highlight inside part of your ecosystem? Oh, thank you so much. So you can find me at robincutcan.com. The first name's hard to spell, R-O-B-N-N-E. The last name's equally hard to spell. C-H-U-T-K. A-N. You can find me on Instagram at Guplis. And, you know, if you like this book, think about checking out one of the others. The Microbiome Solution, which was my second book, is a great deep dive into all things microbiome. So that's a great sort of foundational base. But I am so

delighted to have the opportunity to come on here with you, Drew, and to talk to your audience. You have such a sophisticated community. And it's just such a pleasure to be able to be a part of it. Thank you. My total pleasure. I'm going to continue to follow. And you also have some courses too, I believe that people can do on that? Yeah, we do have a couple courses, so we're offering also and you can find it all there. All on the gut as well. Beautiful. So if you are bloated, if your gut is messed up, if you are trying to figure out how to get less sick and start beefing up before knock on wood, I hope it doesn't come anytime soon. But the next viral pandemic, we have all the resources

for you to your website, to the book. Again, the antiviral gut. It's out. Please pick up a copy. Thank you so much for coming on the podcast. It was such a pleasure. You're so welcome. Pleasure was mine.