The Dr. Hyman Show - Fixing The Root Causes Of Irritable Bowel Syndrome with Dr. Todd LePine

Episode Date: August 10, 2020

Fixing The Root Causes Of Irritable Bowel Syndrome | This episode is brought to you by AirDoctor Millions of people suffer from irritable bowel syndrome (IBS). These people struggle with miserable, often disabling symptoms like bloating, cramps, diarrhea, constipation, and pain. IBS can be caused by a range of factors, including food allergies, overgrowth of bacteria in the small intestine (SIBO), a lack of digestive enzymes, parasites living in the gut, zinc or magnesium deficiency, and heavy metal toxicity. That’s why it is so critically important to personalize treatment based on the unique circumstances that exist for each person who suffers from IBS.  In this episode, Dr. Hyman sits down with Dr. Todd LePine to discuss the numerous underlying issues that can contribute to IBS, what type of testing they conduct when working with patients experiencing IBS, and much more.  Dr. LePine graduated from Dartmouth Medical School and is Board Certified in Internal Medicine, specializing in Integrative Functional Medicine. He is an Institute for Functional Medicine Certified Practitioner. Prior to joining The UltraWellness Center, he worked as a physician at Canyon Ranch in Lenox, MA, for 10 years. Dr. LePine’s focus at The UltraWellness Center is to help his patients achieve optimal health and vitality by restoring the natural balance to both the mind and the body. His areas of interest include optimal aging, bio-detoxification, functional gastrointestinal health, systemic inflammation, autoimmune disorders and the neurobiology of mood and cognitive disorders. Dr. LePine teaches around the world, and has given lectures to doctors and patients at American College for Advancement in Medicine (ACAM), Age Management Medicine Group (AMMG), the University of Miami Integrative Medicine Conference, The Kripalu Center in Lenox, MA, and is on the faculty for American Academy of Anti-Aging Medicine (A4M). Dr. LePine is the head of the Scientific Advisory Board for Designs for Health and a consultant for Diagnostic Solutions Laboratory. He enjoys skiing, kayaking, hiking, camping and golfing in the beautiful Berkshires, and is a fitness enthusiast. This episode is sponsored by AirDoctor. We need clean air not only to live but to create vibrant health and protect ourselves and loved ones from toxin exposure and disease. That’s why we’ve teamed up with AirDoctor to offer you the AirDoctor Professional Air Purifier systems at a special price. Learn more at www.drhyman.com/filter. In this episode, Dr. Hyman and Dr. LePine discuss: The conventional medicine approach to treating IBS Stress and IBS How the gut and the brain are connected Why an IBS diagnosis tells you nothing about the cause of IBS How having a history of colic as a baby, having been vaginally birthed or breast fed, your childhood diet, past antibiotic use, family history of digestive issues, and other information can provide insight into identifying the cause of and treating IBS Small Intestinal Bacterial Overgrowth (SIBO), having a “food baby,” and auto-brewery symptom Types of testing to diagnose IBS, including GI map testing, hydrogen methane breath testing, gastric level testing, IBSSure testing, and organic urine testing The negative effect of long-term use of acid blockers Reasons for IBS including food sensitivities, allergies, parasites, enzyme deficiencies, heavy metals, Lyme disease, autoimmune issues, akkermansia levels, and more How eating a colorful diversity of vegetables and fruits benefits gut health and the microbiome The relationship between the immune system and gut health Common inflammatory foods Stimulation of the vagus nerve for “resting and digesting” Treating leaky gut with prebiotics, probiotics, diet, and nutrients For more information visit drhyman.com/uwc Additional Resources: The Wrong Gut Bugs Can Make You Fat and Sick (and How to Fix Them) https://www.ultrawellnesscenter.com/2017/09/21/the-wrong-gut-bugs-can-make-you-fat-and-sick-and-how-to-fix-them/ Getting to the Root: Tackling SIBO with Functional Medicine https://www.ultrawellnesscenter.com/2019/06/14/getting-to-the-root-tackling-sibo-with-functional-medicine/ 10 Strategies to Eliminate IBS and Create Good Gut Health https://drhyman.com/blog/2015/08/26/10-strategies-to-eliminate-ibs-and-create-good-gut-health/ 5 Simple Steps to Cure IBS Without Drugs https://drhyman.com/blog/2010/09/16/5-simple-steps-to-cure-ibs-without-drugs/ How To Feed Your Gut https://drhyman.com/blog/2018/04/13/how-to-feed-your-gut/ Do Probiotics Really Work? https://drhyman.com/blog/2016/09/08/do-probiotics-really-work/ Hosted on Acast. See acast.com/privacy for more information.

Coming up on this episode of The Doctor's Pharmacy. There's really, you know, listening to the patient. Antibiotic use. Did they have a lot of ear infections? Did they have a lot of strep throat? Did they get a lot of antibiotics? What's going on in the family? Did anybody else in the family have any digestive issues?

So just taking the time to get that history allows you to sort of play detective and try to figure out what are the things that are potentially playing a role in driving this and what might have triggered it. And then personalizing, you know, diagnostics and treatment and everything else. Welcome to the doctor's pharmacy. I'm Dr. Mark Hyman, and that's pharmacy with an F, F-A-R-M-A-C-Y, a place for conversations that matter. And if you've ever suffered from digestive problems, from irritable bowel syndrome, bloating,

and discomfort, you better listen to this podcast carefully because it is a special podcast of the Doctors Pharmacy, which I call the House Call Series. And I'm sitting down with my colleagues from the Ultra Wellness Center in Lenox, Massachusetts. And today I'm joined by Dr. Todd Lapine to discuss how we, as functional medicine doctors, tackle specific conditions we see at our practice every single day. And I'm going to focus today on irritable bowel because that is affecting so many people. It's the number one reason people actually go to the doctor is digestive complaints. It's a big problem and it causes disability and dysfunction

and misery for so many people and it's fixable. So Todd is a great friend and colleague. We've worked together for pushing on almost 30 years now. A long time. We're still standing. He's an extraordinary physician, a leader and thinker in the field of functional medicine. He graduated from Dartmouth Medical School. He's board certified in functional medicine and he worked with me at Kenya Ranch for many years. He teaches all over

the world in various faculties and is just a brilliant functional medicine physician. And honored to have him as part of our center here at the Ultra Wellness Centers. So Todd, welcome to Doctors Pharmacy again. Thanks, Mark. It's great to be here. Okay. So let's talk about this thing called irritable bowel syndrome. What did we learn about it in medical school? Not much. I mean, we, I think we basically learned that it was one of those conditions where you sort of treat the patient and it's not serious. You're not going to die from it. And I can remember actually up at Dartmouth, we had Dr. Almey and he was a, an expert in irritable bowel. And back then it was felt to be more of a sort of neurologic sort of like stress

related thing. Psycho-emotional. Psycho-emotional. And actually I'll tell you this is very interesting side story. He did a test where he took some medical students and was measuring the manometry of them. And while he was doing the sigmoidoscopy, he was measuring the tension in the colon. And then he, while doing the, and this, you can only do this to medical students, and this is back in the 50s. And he told them, he goes, I think I see cancer. All of a sudden there was a spasm of the colon. Oh.

Yeah. And it was like he wanted to evoke to see what it was, what was going on with the irritable bowel. And they thought it was a lot of it was nervous related. Yeah. Which there is a stress component and uh so back then the concept of irritable bowel was that it was all sort of in your head it's all sort of like we had a very uh fancy word for it in medical school we called it super tentorial which is a doctor's way of saying it's all in your head

it's all in your head the tentorium is that thing that kind of separates your top of your brain from the lower brain it was a joke but it was very pejorative. And we often thought that these patients were malingers. It was called functional bowel disease. Yeah, a lot of terms. There was no real cause for it. It was more psychological and maybe stress-related. And these people are all emotional and upset. Turns out it's not so, right? And we call it syndrome, right? Syndrome, yeah.

So when we say syndrome in medicine what do we mean it's a constellation of various symptoms and you know we we now we don't know what the hell's going on we don't know what it's like yeah it's like it's like you know chronic fatigue syndrome you know it's like you know how many different things can cause chronic fatigue it's like there's 23 flavors or how many flavors of baskin robin ice cream same thing with uh 31 i used to be i used to scoop baskin robin's ice cream, same thing with Irdle Bowls. 31. Yeah, 31. I used to scoop Baskin-Robbins ice cream. That was a moment of my job. Right, right.

And that'll probably cause Irdle Bowls. Probably. With all those artificial flavorings and sugar. So, yeah. So, you know, nowadays we sort of classify Irdle Bowls into Irdle Bowls with constipation, Irdle Bowls with diarrhea, and then mixed Irdle Bowls. That's how we're sort of, you know, putting an ICD-10 code on it. And that's a way of conceptualizing it. But there are lots of different things that play a role. Without question, I think stress does play a role

with irritable bowel. And I think that, you know, stress can manifest in the body in so many different ways. We've talked about this when we talk about autoimmune conditions, because oftentimes when we have a patient and some stressful event happens, it triggers a host of things and sort of like a ripple effect that goes on in the body. And without question, there is a stress component to some irritable bowel conditions. Well, yeah. I mean, you've got your second brain in your gut. There's more serotonin in your gut than in your brain. You've got this whole nervous system that connects the two that is extraordinary complex and feeds back both ways. so from the top down and bottom up so

irritable bowel can cause irritable brain and your brain cause it will bow it goes back and forth right and you want to have a happy bowel happy brain that's that's you know that's sounds like the key to a happy life happy happy bowels happy brain exactly exactly and then yeah and there is that it's an interesting thing that you're talking about because you have that gut gut brain connection. And it's like a two way highway in their body, they're basically communicating, the brain's talking to the gut and the gut's talking to the brain. And then you also have the enteric nervous system. And some people sort of forget about the enteric nervous system. And that's the intrinsic nervous system to the gut. So literally, if you if you sever the spinal column, and there is no connection to the gut in the brain the gut still works you can still you know poop uh fine if you if you sever the spine it's got a mind of its own it's got a mind of its own exactly right but you know todd i want to come back to what you said which is really important you said you know we categorize irritable bowel as with constipation or diarrhea or whatever.

And there's a whole classification system that is driven off of symptoms. Yeah. And the difference between functional medicine and conventional medicine thinking about any disease is that it's not focused on the symptoms. It's focused on the causes. So just saying people have irritable bowel doesn't tell you anything about the cause. It tells you they feel uncomfortable. They're bloated.

They have diarrhea. Their bowels are weird. They're uncomfortable, they're bloated, they have diarrhea, their bowels are weird, they're uncomfortable, cramping, whatever the symptoms are, is irrelevant when it comes to trying to figure out the cause. I mean, yeah, okay, you have irritable bowel, but that's when you start to think about the problem. In traditional medicine, you name the disease, you stop thinking. You know, and our colleague, Sid Baker, always had this great term. He says, you know, traditional medicine

is naming and blaming. You name the disease and then you blame the name for the problem. Oh, I know why your stomach hurts. You have irritable bowel syndrome. No, that's just the name of the problem. But he talks about thinking and linking, which is functional medicine, right?

Yeah. You think about the problem and the cause once you get the diagnosis and you link everything together to see what the factors are. And there's no such thing as irritable bowel syndrome. There's irritable bowel syndromes. Like you said, there's 31 flavors and each one is different and each one needs to be treated differently. Exactly. Exactly. Yeah. It's so, so, so true. And there is this web-like interaction in the body and it's very important to understand the whole interconnectedness of it.

It's very, very important. So typically you go to the doctor and you have irritable bowel. What do they tell you to do? Well, you know, they'll often tell you, you know, take some Metamucil and I'll see you later. Eat more fiber, drink more water. Yeah, that's the same. Learn to live with it. Yeah, that's essentially what they more fiber, drink more water. Yeah. That's, that's the same. Learn to live with it. And that's essentially what they're doing with stress. Yeah. That deal with stress. Yeah. And they'll, they'll, the interesting thing, this is,

I had a patient just the other day, uh, who I was seeing for, um, uh, GI symptoms. Um, it wasn't specifically irritable bowel and the patient's GI doctor said, diet has nothing to do with your symptoms. I mean, it was, it was unbelievable that a GI doctor told, diet has nothing to do with your symptoms. I mean, it was unbelievable that a GI doctor told her diet makes no difference. I couldn't believe it. I just, I like. Actually, I was on a consult with a patient yesterday and she said, I went to my gastroenterologist and I wanted to show my stool test. He says, oh, gastroenterologists don't look at stool. I'm like, well, then who does if you're a doctor? And I'm like, you know, that just doesn't make sense. You don't look at what goes in and you don't look at what comes out. How are you

supposed to know what's going on in there, right? And that's the difference in functional medicine. Yeah, exactly. Yeah. It's a little's, it really, it's, it's sort of, it's a little bit mind blowing. And yeah, you know, you talk about like, you know, with going back to Sid Baker and sort of name it and claim it kind of a thing is. Blame it. Yeah. Name it, name it and blame it. Is that, you know. And then tame it with a drug. Right. And then I, I always, I always tell my patients, you know, I went from being a medical student to a student in medicine. I'm a, I'd like to always learn about things. I love that. learn about things. And yeah, and it's a very important thing that you have to remain open minded. And I think you also have to remain curious, because every patient is different.

That's, you know, that's actually the joy of actually practicing functional medicine is it's not boring, by any means. It's, you're constantly growing and learning and helping patients with the latest diagnostics, the latest therapeutics, to personalize their treatment. And that's the fun part. I mean, doing functional medicine is a wonderful profession, uh, as opposed to regular mainstream medicine where most doctors are burned out. You know, they're, they really are. They're just, they're unhappy. They're, they're burned out. They're, they're doing the rubber stamp medicine. You know, I'll see you, here's your proton pump inhibitor. Next, next patient. That's yeah right that's it right that's it so you know doctor sees you you have irritable bowel they give

you metamucil what else can they do sometimes well sometimes they'll give prescription medications i think one of the older ones that they used to do for ibs was zelnorm remember that one yeah they took it off the market because it was like really hurting people i think people are getting librium was the other one remember that that was that was a like a valium yeah it's basically taking value is it valium for the gut yeah yeah and they're actually in certain patients uh there were some benefits from that because it did sort of calm down uh the nervous system i think uh sure anybody anybody taking value you're gonna feel i feel good a couple of shots of tequila a little i feel good right but that's really not what we do with medicine you're you know you were talking before about how you never know what the issue is when someone comes in i was thinking about it's much

like forrest gump medicine you know forrest gump has a box of chocolates life was like a box of chocolates you never know which one you're gonna get and i think in traditional medicine you got irritable bowel it's a thing you treat it all the same. Functional medicine is not like that. We see someone with irritable bowel and then we go, wait a minute, what is the cause of their irritable bowel? And like you were saying before, it's very personalized. So how do we start to think about identifying what their particular issues are? Because before we can even treat it, we have to understand the why.

And that is what I always say. Functional medicine is the medicine of why and regular medicine is the medicine of what? What disease and what drug? And I think the big thing is time, taking the time to talk to a patient. What? Talk to a patient? Actually, and listen to the patient. Wow, listen to the patient. That's actually, you know, sometimes the less I talk during an interview and, you know, evaluation of a patient, the better I do.

Because oftentimes we want to jump in and ask this question. They'll say something and we ask a question. I think in the average doctor's office, a patient speaks for like 30 seconds and the doctor interrupts them. Yeah, no, actually, there was a study published years ago in JAMA. It was 18 seconds before the doctor interrupts. Exactly, because we're trained to probe the questions, and they have their own sort of path of thinking going down that. But I think the big thing is we spend a lot of time listening to the patients

and getting a history and a story. And an important thing is an interesting thing in terms of IBS patients is that babies who have colic, and they've actually looked at what is it that causes colic in babies. The latest evidence is that babies that have colic have high levels of Klebsiella. Klebsiella is a bacteria. And we know that Klebsiella is actually associated with other inflammatory conditions and autoimmune conditions. So Klebsiella excess in the gut is actually associated with ankylosing spondylitis, which is an inflammatory bowel disease which manifests systemically with arthritic symptoms.

So getting a history of colic is important. Listening to the history of, you know, were they vaginally birthed? Were they breastfed? What type of diet did they have as a kid? And when did they get food introduced? Yeah. And all those things can play a role in terms of early gluten. Yeah, exactly. Yeah, exactly. Trigger leaky gut.

Exactly. And, and just there's really, you know, listening to the patient, antibiotic use, did they have a lot of ear infections? They have a lot of strep throat. Did they get a lot of antibiotics? What's going on in the family? Did anybody else in the family have any digestive issues? So just taking the time to get that history allows you to sort of play detective and try to figure out, okay, what are the things that are potentially playing a role in driving this and what might have triggered it? And then personalizing, you know, diagnostics and treatment and everything else. It's all about personalization. I think it's very, very different what you're

saying. This approach really is being a medical detective. Absolutely. And it is relevant whether you're breastfed or, for example, or vaginally birthed because that affects your gut flora and the development for your whole life. I mean, I recently read a study that showed bottle-fed babies have high levels of what we call a short-chain fat, which is made by the good bacteria. This one is called propionic acid now this is not such a good one and it's been shown to induce autism in animal studies and has been associated with autism and add that is increased when you're bottle feeding when you breastfeed you get increased in butyrate which is the beneficial short chain fat that actually

heals the gut and absolutely reduces inflammation there's all sorts of good things so we we think, oh, it's a difference, bottle-fed, breastfed. That's not to make people feel guilty if they have to bottle feed. You have to do it sometimes. But you can fix that by making sure they have the right prebiotics and the right probiotics. Because breast milk has undigestible fibers that are prebiotics and sugars that are prebiotics for the good bugs that aren't actually digested by humans. So breast milk knows that. Exactly.

And the other interesting thing about breast milk, I mean, you know, if we could sort of bottle breast milk, it's very, very powerful stuff. There's a thing in breast milk called milk oligosaccharides. And these are very, very complex sugar moieties, sugar chemicals. And they're actually so complex that for a long time, science didn't even study them because they were too complex. It was like this, you know, a Lego set that was this incredible building blocks. And what they've done now, there are a couple of companies, one company in specific out

of Europe has actually synthesized one of the oligosaccharides in milk. And there are actually hundreds of them. And these act like fertilizer for the good bacteria. So these things that are found in breast milk are very, very powerful things. Yeah. Yeah. So powerful. And so we dig down into the story and figure out when did it start and what's connected to it. Did you have foreign travel? Because people often have post-infectious irritable bowel syndrome. People can get it after antibiotics. People can get it after any kind of stress or trauma. And people don't realize that it's connected to of stress or trauma. And people don't

realize that it's connected to so many different things. So let's talk about what are the causes, and then we'll go into sort of a case of how we would deal with this. So what are the top causes that you found in functional medicine that are driving irritable bowel syndrome for people? Well, a lot of irritable bowel also is probably misdiagnosed, I think, as sort of SIBO. I think a large number of, and SIBO is this diagnosis of small intestinal bacterial overgrowth. So a bunch of people with irritable bowel have SIBO or bad bugs growing where they shouldn't be in the small intestine. Exactly. Yeah. And I think that we're sort of finding that a lot of these people that we're diagnosing with this catch-all term is real they're

really having potentially small intestinal bacterial overgrowth there are tests that you can do for that uh we do the that's also known as a food baby when you eat food and you get a big bloated tummy right after and as a food baby that's what SIBO is right because what's happening is is the you know there's we have bacteria on our skin we have bacteria in our mouth we have bacteria in our stomach the small intestine large intestine our mouth, we have bacteria in our stomach, the small intestine, the large intestine, most of them sort of live in the colon. But there are times when the colonic bacteria

start migrating upwards and they go higher up and it's sort of like invading a neighborhood. That's, you know, and they- It's mostly sterile up there. Most, yeah, it's, yeah, it's not, it's, I think it was not necessarily, we've always thought it was sterile, stomach has bacteria right um and but it's just much less and they're all different kinds of bacteria so the the lower uh bacteria are more

fermenters they they ferment things yeah and that's where we get i think i have talked about that i and i uh i've seen this a couple of times, the auto brewery syndrome where patients, in fact, I just recently had a patient, a fantastic case. And he actually heard me on one of the podcasts where I was talking about auto brewery syndrome. So I did a consult with him and he ended up going and buying a breathalyzer. Yeah. And he confirmed that he has auto brewery syndrome because he was producing alcohol. He was driving over the limit. He was driving.

He was just short of the limit. Saves you money on beer for sure. It was actually quite interesting because he actually was doing a very strict low carb, no sugar diet. And even with a really good diet, he was pushing making alcohol. It's really quite interesting. So yeah. But anyway, so talking about how do we diagnose this? So you can do stool testing. I like the, the, the GI map test where you can do quantitative PCR for bacteria, yeast, fungi. That's looking for the, like the genetic material of the different. Yeah.

It's like CSI. Yeah. You see a CSI. It's, it's, I find it to be a very, very helpful tool. You can also do the hydrogen methane breath test. Although the thing about the hydrogen methane breath test is that i've had some patients who have significant you know irritable sebo type symptoms they're bloating and they're negative and they're negative and i think based upon my reading of literature is that they're probably producing hydrogen sulfide yeah uh and i think

that when you just sort of get a history of in a past very foul smelling gas it smells like rotten eggs that's usually the the people that are producing hydrogen sulfide. Yeah. People don't realize it, but, you know, cows just don't produce methane. Humans can produce methane. Exactly. If you have this. And we measure that coming out in your breath.

We measure hydrogen. We have you take this drink. And that's really a clue that there may be these bugs growing in there. And they have to be treated directly. And that can really help a lot of people. Oh, huge. Huge amounts, Yeah. And it's often missed. It's, it's, it's very much missed. And, and, and you also have to do the test properly because you know,

everybody produces small, small amounts of hydrogen and methane. It's just that you want it lower down in the colon. It really doesn't become as much of a clinical issue. The other thing is to also think about in those types of patients is to make sure that they have sufficient amounts of stomach acid. Stomach acid is very, very important at helping with the proper digestion. So you can actually do testing for gastrin levels. And I've been surprised at how many people have high gastrin levels. So when you don't have enough stomach acid, your body

produces more gastrin, which is the hormone to pump out more hydrochloric acid. It's like clogging a dead horse. Exactly. Absolutely. And I would venture to say that most people's issues are not high acid in the stomach. It's low acid. Yeah. It's low acid.

And we're taking more of these acid blockers, which, by the way, also cause irritable bowel. So they help your heartburn, but they cause trouble bowel. And now there is a role for short-term use of these acid blockers. Like in the ICU, the studies have been shown they've been very helpful to prevent stress-induced ulcers and hospital-acquired pneumonia. But they're really to be used short-term. And when you start using them long-term, they are very toxic. They are very toxic. They produce increased intestinal permeability

they cause malabsorption of nutrients vitamin b12 iron other trace minerals yeah and and they cause bacterial overgrowth and they cause osteoporosis and pneumonia absolutely oh yeah huge huge yeah and I actually I I am really surprised that these things are over-the-c. They really should not be over the counter. Yeah, no, I remember. I've talked about this before, but I remember when I was in medical school, the rep, these just came out, and the drug rep was like, these are super powerful drugs.

You never want to give them more than six weeks. They're designed to treat ulcers. After six weeks, you've got to stop them. Don't take them long term. And now people eat them like candy all day long, every day. And I'm like, this is not good. And we see so many complications from that. So if your irritable bowel is there and you have these acid blockers that you're taking,

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we could talk about how to treat that, but essentially it's killing the bad bugs and reseeding the gut. And what other things are driving your bowel besides that? Well, also you can also potentially have problems with part of the intestine that causes peristalsis. So normally you think of the gut is like this conveyor belt. It's always moving things through. So you eat and within about 24 hours, everything should sort of move through. And there are some patients, especially with the patients who have problems with constipation, that will have problems with motility or really motility disorders. And there's a test. Maybe just not moving down.

Not moving down. And there's a part of the intestines which is called the migrating motor complex. And you can actually test for antibodies against the migrating motor complex. It's called IBSure test. And I'll do that in some- It's almost like an autoimmune thing. Yeah, it's a little bit like a paralysis, if you will, or a weakening of the gut. And we talked about that earlier, how in some cases, you'll have patients who have Lyme disease. I actually had a very good integrative gastroenterologist who brought

my attention to this, is that he had a lot of patients who had refractory SIBO. So, you know, SIBO was one of those things where it sometimes can come back and oftentimes does come back. And what he was finding is that some of the more difficult patients with refractory SIBO actually had underlying Lyme disease. And Lyme disease affects the nervous system. He tied the two together because there is a paper, it's called Bell's palsy of the gut. And in fact, Bell's palsy is where you get facial paralysis. And I'll never forget this.

When I was in my private practice, the first time I saw a real acute case of Lyme disease, the patient presented with Bell's palsy. So her face was paralyzed. And I did testing on her, and the patient had acute Lyme disease. And that is one of the known complications. And it's thought that also that Lyme disease can actually affect the gut. And you get paralysis and decreased motility of the gut. Yeah, so that is a very important point.

Because there are the typical things that go on, food sensitivity, gluten, dairy. Some people react to the chemicals in food that are food additives. Food additives, food colorings. Food colorings, sugar, alcohols. Emulsifiers. Emulsifiers. All these things that are in our junk and processed food do have a huge impact on people.

There's obviously the SIBO. Some of the people get parasites. Yeah, little microscopic hitchhikers. Yeah, and there's one called blastocystis, which is really common. It doesn't cause a horrible disease, but it can cause irritable bowel in about 30% of people with IBS who have this. I want to venture to say that I have picked up a lot of these. I call them little microscopic hitchhikers.

When you actually look in the mainstream literature, they basically say that a lot of these, you don't need to treat it. So there are times when somebody can, they have dientamoeba, histolytica, and blastocystis, and sometimes endolimax, nana. And sometimes people will have these and they'll have a small amount of them. And they may not cause any symptoms whatsoever. But if I find them in the stool test and patients are having symptoms, I treat them. Yeah, absolutely.

And then there's also other things. People have like enzyme deficiencies we can see on stool tests, they're not digesting their food well. And also, you know, for me, I had terrible irritable bowel, you know, almost 30 years ago. It was from mercury poisoning because mercury affects all your enzymes. It basically interrupts the enzyme function of many different enzymes throughout your body including your gut and until i got rid of the mercury my herbal valve wouldn't go away no matter what i did yeah i just ate turkey and broccoli and brown rice for six months and nothing worked and that's and that's and so you have to keep

being a detective and thinking about what are all the variable causes and we look at the stool testing we look at breath testing for bacterial overgrowth. We look at organic acid urine testing to see if there's markers of bugs in there. And we sometimes dig down deeper to look at things like metals or Lyme or other tick infections. So there is a real deep thinking about what is going on with this person. And it's guided by their history, right? Exactly, yeah. And it's guided by their history right exactly yeah it's it's and it's personalized it really is it's it's you know it's it's totally personalized and it takes time

to figure that out yeah uh and you know sometimes it may take several visits i mean you you you and i have had patients where we've been seeing them for a long extended period of time and they're you know they're getting they make some progress they get better uh they may backslide they may you know then they'll have incremental things. So we sort of uncover, as you say, the layers of the onion. Yeah, no, it's true. I had a very bizarre case once. It just reminded me of who was suffering terribly from digestive issues for years and years,

was overall systemically inflamed. And it turned out he had babesia, which affected his gut. Wow. He also had histamine intolerance. Histamine, that's another one. There are histamines in food. And so we put him on a low histamine diet, which treated his Babesia, and his symptoms got better. So sometimes it's a little bit of a roundabout way to think about it.

But what case have you seen in your practice that sort of stood out for you around irritable bowel? Oh, I recently had a patient who came in with a diagnosis of irritable bowel. That was the official diagnosis. And interestingly, she gave me through the history that her symptoms seemed to have been triggered when she had Lyme disease. And her Lyme disease also was complicated by POTS, which we've talked about before, which is postural orthostatic tachycardia, which basically means that you have autonomic nervous system dysfunction as relationship to Lyme. So that sort of- Means when you stand up, you get dizzy.

Yeah. When you stand up, you get dizzy and your heart starts going really fast. And so, you know, there are certain, a couple of things that, you know, that make me think about Lyme disease. So when I have a patient who's got POTS, and sometimes people just come in and that's their only diagnosis is POTS. I said, okay, well, why do they have POTS? Yeah. I love medical terms, postural orthostatic hypotension, which is called POTS. It sounds like a fancy diagnosis. What does it mean? It means when you stand up, your blood pressure drops. It doesn't tell you anything about why or what caused it. And it's just, it's like so frustrating to me that nobody keeps thinking about what's

going on here with these patients so they can actually fix the problem. Right, right. So this lady had this history of Lyme and POTS. And then she ended up having cancer of the uterus and went through radiation. She was supposed to get like 25 rounds of radiation she had to stop at 12 because she developed diarrhea uh-huh um and uh radiation colitis radiation colitis radiation and right is exactly and um believe it or not you know the doctors who were treating her said oh that has nothing to do with your symptoms i mean they

literally you know they didn't want to they didn't want to, they didn't want to, you know, admit that it was from the radiation. Exactly. Exactly. Yeah. Yeah. And then she came in and she actually had had some testing done previously. And what I, what, what, and I think the doctor who actually did the testing didn't know how to interpret the test properly, but the patient's calprotectin was elevated. So calprotectin is a biomarker in the gut. I call it like CRP of the gut. So we have this compound, which is called high sensitivity C-reactive protein. When it's elevated, it is a biomarker of systemic inflammation. And it's also highly correlated with heart disease. And calprotectin is found in the gut. And it's sort of like the crp of the gut so when you see that you see it's high inflammation yeah exactly so it tells you and usually you know for classic

you know what we call irritable bowel syndrome you don't usually have inflammation per se it's not really dramatic inflammation there's dysfunction but there's not inflammation so her irritable bowel was actually partly inflammation. And I think that was one of the big things that was driving it. The other thing on this particular patient is that she had on her testing undetectable acromantium and synophilia. That's a big word. All right. So this is a mucus-loving bacteria.

And what we found is that higher levels of this is correlated with leaner body mass less chance of obesity less chance of diabetes and uh it's also uh you want to have higher levels of this because it's a protective good bug it's not it's not it's not a probiotic immune disease yeah risk of cancer yeah so and it's not a it's not a bug that you can go out and get a pill for at least not yet uh eventually we might uh because it's so beneficial but that you can go out and get a pill for, at least not yet. Eventually we might because it's so beneficial. But what we find out is that this particular bacteria feeds on fibers, specifically polyphenols. What are those? Polyphenols are those compounds that are phytonutrients found in lots of colorful foods and vegetables

like pomegranate and green tea and cranberries. So your little bugs like cranberry, pomegranates, and green tea. Exactly. They love that stuff. This is their, you know, I call it the miracle girl. You know, that's a miracle. You put this stuff on there and the good bugs flourish. There's a fairly no understanding, you know, because we thought, okay, you need prebiotics, you need probiotics.

But I think the polyphenols are also critically important to optimizing your gut flora, the three Ps. Yes, exactly. And the other thing, which I always come back to when I think about the digestive tract is, it's a beautiful visual, is the rainforest. And for anybody who knows about rainforest, rainforests are full of biodiversity. There's lots of flora and fauna. There's frogs, there's birds, there's all different plants, insects, worms. And the more biodiversity that you have in your personal internal rainforest, the healthier you're going to be. And there's tons of studies that have shown this. And it's nonlinear. It's very, very complex because there's this whole ecosystem and there's this cross-feeding and interaction that happens when you have a diverse internal

rainforest. Yeah. It's so true. I was talking to a professor at Harvard who's a psychiatrist and also runs the Department of Nutritional Psychiatry. And she's written a book called This Is Your Brain on Food, talking about the microbiome and its effect on psychiatric illness. Absolutely. So we used to think that the crazy person would have the gut problems. Turns

out the gut problem people have the crazy thing upstairs because of the gut thing. And fixing the gut fixes the depression, anxiety, OCD, all these crazy things that we thought of our psychiatric illnesses. Turns out they're really related to the imbalances in the microbiome and the lower diversity. And Western societies have increasingly lower diversity. Oh, huge, huge. Yeah, exactly. And it happens very, very early on. And what typically will happen is, you know, there are some people that, you know, they're very picky eaters and they'll be eating the same food over and over and over. And, you know, I always tell patients that you want to try to increase your intake of diverse fruits, vegetables, try to eat and see.

Right now in the Berkshires, we have lots of great vegetables that are available that you may not get year-round. And eating, I call it, you want to eat a Crayola crayon box. The more color you have in your diet, the healthier your diet's going to be. And I want to come back to something you said before about this inflammation in the gut. There's a whole new phenomenon we call pre-inflammatory bowel disease. So we thought irritable bowel wasn't inflammatory. It turns out even if you can't always detect it, it tends to be very inflammatory.

And there are cases, like you saw,, people with this pre-IBD. So it's like pre-Crones or pre-colitis. Yeah, it's not like one night you wake up and all of a sudden you've got Crohn's disease. Yeah, exactly. So there's this level of this marker we check and it's often elevated and people have, not full-blown Crohn's disease,

but something's going on in there that's driving inflammation and you have to deal with those factors. Exactly, yeah, exactly. So this patient, she also had elevated gluten antibodies, right? So she had this low acromantia. She had elevated gluten antibodies and this high calprotectin. And so this is a sort of a perfect setup for having a messed up gut. Absolutely. Yeah. So how would you take care of this patient then who came in with the gluten issues, the low acromantia, and the calprotectin? Well, I mean, to address the inflammation. And by the way, these are something

that your traditional doctor will never look for, that we usually look for in functional medicine at the Ultra Wellness Center, sort of standard operating procedure for us to really look at these things. Yeah. So, you know, to treat inflammation, I always like to check the omega-3 fatty acids. Because when you have low essential fatty acids, you're a setup for inflammation. So in this particular patient, the patient had suboptimal omega-3 fatty acids, which relate to eating cold water fish. So I got her to take some supplemental omega-3 fatty acids, had her increase her fish intake. I used an anti-inflammatory supplement called Ultra Inflamex, which has a powder curcumin and other things to help decrease inflammation in the gut. Ginger, rosemary.

Exactly, ginger and rosemary. And then also used Interagam, which is an immunoglobulin that helps with patients who have sort of diarrhea type. That's actually a prescription medication. So tell us more about what is this immunoglobulin stuff? Because you hear a lot about it. Yeah, it's serum bovine derived immunoglobulin. It's basically colostrum. Yeah, you can think of it as like colostrum. And yeah, colostrum is, you know, colostrum is that stuff that in mother's milk that is before the milk comes on.

And it gives immunity to the baby. Exactly. Yeah, It's passive immunity. So it's the mother's immune system that's passed down to the child. So, which is really quite amazing when you think about it from an evolutionary standpoint, that the mother's immune system has evolved and learned what to deal with and how to deal with it. And then that immune system gets literally transferred in the breast milk to the baby. Until the baby can actually develop its own. Exactly. Exactly. And the interesting thing is our immune system has to learn. It's got to go to school. And that's why when you see these little

kids who are crawling around on the ground and they're putting stuff in their mouth, we're developing what's called mucosal tolerance. It's the immune system learning to deal with the planet Earth. And it realizes that, okay, you're going to be around a lot of these things. You don't want to overreact to it. And we always talk about what is a healthy immune system? Well, a healthy immune system is a tolerant immune system. Yeah. It doesn't overreact or underreact. Exactly. That's the key thing. And I always say to people, I want a strong immune system. Well, if you have a too strong immune system, that's called autoimmune disease. Right. When your body's reacting to everything and it's like overreacting. So having tolerance and mucosal tolerance is really, really important. And the other thing,

which in some of the lectures I do, and I like to emphasize this, is you can think of, we have the Boston Symphony Orchestra, and unfortunately, Tanglewood is not open this season because of COVID. But in the Boston Symphony Orchestra, you have the conductor. And the conductor, you know, balances the woodwinds and the strings and everything, and they sort of keep everything in balance. And in the immune system, we have cells called the Treg cells. And the Treg cells regulate the immune system between the various parts of the- So like make sure it's not too hot, not too cold. Exactly.

Exactly. And guess what helps with Treg cells? Fiber. What? Fiber. Yes. So when you're eating lots of fiber, you upregulate your Treg cells. Other things that can do that, vitamin A can do that too.

But fiber is probably one of the biggest things that helps with the Treg cells. Other things that can do that, vitamin A can do that too, but fiber is probably one of the biggest things that helps with the Treg cells. Yeah, and functional medicine is really practical too, because when you have a patient with any condition, particularly with gut issues, which is often driving so many things. So even if you don't have quote irritable bowel, a lot of health conditions are driven by imbalances in the gut. Like we talked about psychiatric issues, heart disease, obesity. But we have a very specific framework called the 5R program, which we use to methodically treat and restore gut function. And we've been doing it for decades, even before people called it the microbiome.

Our goal was to really optimize the microbiome as a way of treating all sorts of diseases. So how would we do that in this patient? Obviously, you've got rid of the gluten, right? Yeah, obviously, in a patient to decrease inflammation, you can decrease the foods that typically drive inflammation. So things like trans fats can drive inflammation. Sugar drives inflammation. Dairy, big thing, especially cow's milk. Sheep and goats tend to be less inflammatory. I'm not sure why that is. It's because of the A2 casein. Oh, A2 casein. Okay, that's it. There you go. Yeah, A1 casein is very inflammatory, which is all the modern cows, all the heirloom cows and sheep and goats still have A2 casein, which is

less inflammatory. It tends to cause less digestive issues for people. Yeah. And then gluten is a big driver. And then other things that are found in foods, like we talked about things like emulsifiers and artificial- Processed foods. Processed foods, exactly. If you can't read it on a label, don't eat it. Yeah, yeah. Yeah, you don't eat it. Another one, which is, I'll mention this, is titanium dioxide. Yes, I was just reading about that. Exactly. Tell us about that. Yeah, it's bad.

It's the thing that they add to food to give it whitening. And they'll use it in a lot of products, gums, they use it in such. It's in a lot of vitamins you get at the drugstore, too. Exactly. And titanium, your body does not like titanium. It's a metal and your body body can react to it and it's it's almost like a nanoparticle metal that you're putting in the body and uh it's been shown to uh the gut does not like it and one more reason to not eat processed food exactly all right so so

you've gotten we're removing the foods we're removing these processed ingredients moving trans fats gluten dairy other food sensitivities i had, for example, had diarrhea for years and years. She had a sensitivity to eggs. It wasn't an allergy. She got rid of the eggs and her diarrhea went away. Yeah. You know? And there are some times where, you know, doing a strict elimination diet to try to

tease out, because food is complex. There's lots of things when you're eating food. And there are also some patients that you, I know you've probably done it yourself, where sometimes you've got to put them on what's called an elemental diet, where you basically give them an amino acid. Predigested. Predigested, exactly. And that helps to sort of calm down and quiet the gut. In fact, mainstream doctors will do that for patients where they'll actually put them on parental nutrition, where they just give them it through the, they sort of rest the gut.

Yeah. I mean, we're going to be having a podcast with one of our nutritionists. We're going to be talking about the elimination diet and why we do it and how we do it. And there's lots of different versions, particularly for IBS, the FODMAP diet. There's a specific carbohydrate diet. There's a traditional elimination diet. So I think this is a really important thing is to get rid of the things that are causing the problem. And then we look for parasites and other bad bugs, SIBO, breath testing. So we actually clear out all the bad stuff. Yeah. Take out the bad and put in the good. What's the next step for how to repair the gut on the five-hour program? Well, you can re-inoculate. Sometimes you can use probiotics

along with prebiotics. We call that synbiotics. The big thing you've got to watch out with that, and you've probably seen this, is if you add that in too soon, you can actually sometimes flare up bloating symptoms. Yeah. It's like a war between the good guys and the bad guys. You got to clear out the bad guys first. I call it the weeding, seeding, and feeding program. First, you got to do the weeding. Then you got to seed the good guys and then you got to feed them. Yeah, exactly. Yeah, that's exactly right. And then the other thing that's also important, just that sort of helps with digestion is, and I've been using this more and more, is stimulation of the vagus nerve. So the vagus nerve, we have the autonomic nervous system in the body. And there's,

my analogy is the gas pedal and the brakes. And the gas pedal is a sympathetic, so it sort of gets things going and the brakes sort of slow things down. So the stimulating of the vagus nerve is resting and digesting. And that's what you want to be doing. You want to be in a relaxed state when you're digesting your food. And we tend to have a sympathetically driven society. You know, running, going. We're, you know, always on the go. That's why people say prayers are grace before eating.

They calm everything down. Yeah. Right? Yeah. And we just kind of eat on the run, eat on the car. Yeah. People walking down the street. And we're all guilty eat on the run eat on the car yeah and people walking down the street and we're all guilty of that because we're watching tv yeah that the worst

thing is actually i call unconscious eating you know it's like you're sitting in front of watching a movie you get the popcorn all of a sudden the big bowl's gone well they actually did those studies they literally have a secret trap door on the bottom of the bowl and they like fill it up from the bottom and people just keep eating and eating exactly unconscious eating it's like stop exactly exactly uh okay so so the five-hour program is basically remove the bad stuff uh basically replace the things that are missing digestive enzymes and prebiotics re-inoculate and then repair which is repair the next phase which how do you fix a leaky gut right yeah? Yeah, and you talked about butyrate. Butyrate is one of the things that's very helpful for leaky gut,

and I've been using that in supplement form. Yeah. I also encourage fiber use, and glutamine can be very helpful. Aloe can be really helpful. Quercetin or other things. Vitamin A, zinc, fish oil. Zinc in the form of zinc carnosine is also, there's some really interesting studies on that with leaky gut

because when you take things like Advil or Aleve, those things cause transient leaky gut. So you're going to develop leaky gut. And for people who are taking them chronically, they've shown that just taking zinc will help repair the gut with the NSAIDs. So it's really a very specific methodology of diagnosis and treatment. And the hit rate is pretty high on this.

I mean, I think people come in with these chronic lifelong digestive issues. I just talked to a patient yesterday, and she'd been struggling, struggling, struggling. Then she had a parasite. She had bacterial overgrowth. She had all these issues. And within a couple of weeks, she had all these issues. And within a couple of weeks, she's back to normal. And I think people are just sort of shocked.

And one of the things you use in this patient is a gut shake that kind of combines a lot of these things that helped grow her acromantia. Exactly. Yeah. So the gut shake is full of polyphenols. It contains things like cranberry, pomegranate, maca. Matcha. Matcha, matcha. I call it matcha. Green tea. Matcha, matcha. Right, right. Matcha, not maca. Yeah. And it's got the immunoglobulins, which are talked

about, that help kind of regulate the immune system in the gut. Prebiotic fibers, probiotics. Yeah, and again, I call this sort of like miracle grow for your rainforest. It just helps with biodiversity. It helps with this flourishing of the good guys, which have their own way of keeping things in check. It really is. So for those listening who have irritable bowel, who've been suffering for a long time

without help, there is help. You don't have to suffer. It's actually not that hard to fix. It's sort of embarrassing how easy it is once you know what to do. But most of us in medicine, we're not trained on how to approach this systemically or systematically. And that's what functional medicine is. It's a systematic approach that looks at the causes and then restores normal function, hence the name functional medicine. And we've been doing this at the Ultra Wellness here for, gosh, I don't know, decades now.

With all of us together, we probably have 65 years of clinical experience and we all are faculty and teach all over the world. So I think your stories and my stories just go back so many years and help us really know that we have a way through this and people don't have to suffer. So people are listening and struggling. I encourage you to get help through

a functional medicine doctor here at the Ultra Wellness Center. We're doing all virtual visits now. People, well, we also, you can come in for sure, but we do virtual so you can get new patient virtual consults. And we're really happy to help anybody who needs help because this is a terrible problem to suffer with. And there are answers and there's a way to figure it out. And it ain't that hard. And I personally have suffered from it. So I get it. And it's just no fun. So I think, Todd, you are a wealth of knowledge. And I'm so glad to have you back on the podcast. And I'm just wondering out there, if you struggle with this, please share your story with us, leave a comment and subscribe wherever you get your podcasts.

And we would love to have you share this with everybody because I think there's a lot of people out there with it. We'll bow. And then we'll see you next time on the doctor's pharmacy. We want to have everyone to have happy guts, happy gut, happy gut. Happy gut. Hey everybody, it's Dr. Hyman.

Thanks for tuning into The Doctor's Pharmacy. I hope you're loving this podcast. It's one of my favorite things to do and introducing you all the experts that I know and I love and that I've learned so much from. And I want to tell you about something else I'm doing, which is called Mark's Picks. It's my weekly newsletter. And in it, I share my favorite stuff from foods to supplements, to gadgets, to tools to enhance your health. It's all the cool stuff that I use and that my team uses to optimize and enhance our health. And I'd love you to sign up for the weekly newsletter. I'll only send it to you once a week on Fridays, nothing else, I promise. And all you do is go to drhyman.com

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