The Dr. Hyman Show - What Is Leaky Gut And How Can You Treat It? with Dr. Elizabeth Boham

Episode Date: March 20, 2020

Most of us (including most doctors) do not recognize or know that digestive problems wreak havoc in the entire body, leading to allergies, arthritis, autoimmune disease, rashes, acne, chronic fatigue, mood disorders, autism, dementia, cancer, and more. So having a healthy gut means more than simply being free of annoyances like bloating or heartburn. It is absolutely central to your health. It is connected to everything that happens in your body. That is why Functional Medicine almost always starts helping people treat chronic health problems by fixing their gut. In this mini-episode, Dr. Hyman is joined by Dr. Elizabeth Boham to review two patient cases focused on treating the gut. Elizabeth Boham is a physician and nutritionist who practices functional medicine at The UltraWellness Center in Lenox, MA. Through her practice and lecturing she has helped thousands of people achieve their goals of optimum health and wellness. She witnesses the power of nutrition every day in her practice and is committed to training other physicians to utilize nutrition in healing. Dr. Boham has contributed to many articles and wrote the latest chapter on Obesity for the Rankel Textbook of Family Medicine. She is part of the faculty of the Institute for Functional Medicine and has been featured on the Dr. Oz show and in a variety of publications and media including Huffington Post, The Chalkboard Magazine, and Experience Life. Her DVD Breast Wellness: Tools to Prevent and Heal from Breast Cancer explores the functional medicine approach to keeping your breasts and whole body well.   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. Learn more about the AirDoctor Professional Air Purifier system at a special price at www.drhyman.com/filter In this episode, Dr. Hyman and Dr. Boham discuss: What is leaky gut, and why does it lead to so many other health issues, including food sensitivities? How our diet, food supply, over-reliance on antibiotics, acid blockers, steroids, and more can lead to leaky gut Using stool testing and Cyrex testing to assess gut health. The ‘5R’ program (remove, replace, reinoculate, repair, and rebalance) that Functional Medicine uses as a guide to treat chronic issues.  Remove stressors: get rid of things that negatively affect the environment of the GI tract including allergic foods and parasites or other bad bugs such as bacteria or yeast. This might involve using an allergy “elimination diet” to find out what foods are causing GI symptoms or it may involve taking drugs or herbs to eradicate a particular bug.  Replace digestive secretions: add back things like digestive enzymes, hydrochloric acid, and bile acids that are required for proper digestion and that may be compromised by diet, drugs, diseases, aging, or other factors. Reinoculate. Help beneficial bacteria flourish by ingesting probiotic foods or supplements that contain the so-called “good” GI bacteria such as bifidobacteria and lactobacillus species, and by consuming the high soluble fiber foods that good bugs like to eat, called “prebiotics.” Probiotics are beneficial microorganisms found in the gut that are also called “friendly bacteria.” Use of antibiotics kills both good and bad bacteria. Probiotics in the form of supplements or food are needed to re-inoculate the gut. Fermented foods, such as yogurt, miso, and tempeh are food sources of probiotics. Prebiotics are nondigestible food ingredients that selectively stimulate the growth of beneficial microorganisms already in the colon. In other words, prebiotics feed probiotics. Prebiotics are available in many foods that contain a fiber called inulin, including artichokes, garlic, leeks, onion, chicory, tofu, and other soy products. Grains such as barley, flax, oats, and wheat are also good sources of prebiotics. Another good prebiotic source is a supplement called “fructo-oligosaccharide” or FOS. Repair. Help the lining of the GI tract repair itself by supplying key nutrients that can often be in short supply in a disease state, such as zinc, antioxidants (e.g. vitamins A, C, and E), fish oil, and the amino acid glutamine.  Rebalance. Pay attention to lifestyle choices – sleep, exercise and stress can all affect the GI tract. For more information visit drhyman.com/uwc Additional resources: “Is Your Digestive System Making You Sick, and Fat?” https://drhyman.com/blog/2010/05/20/is-your-digestive-system-making-you-sick/ “How to Feed Your Gut” https://drhyman.com/blog/2018/04/13/how-to-feed-your-gut/ “A New Approach to Autoimmune Disease” https://ultrawellnesscenter.com/2018/06/27/a-new-approach-to-autoimmune-disease/ “Lab Spotlight: Testing for Food Sensitivities” https://ultrawellnesscenter.com/2019/09/27/lab-spotlight-testing-for-food-sensitivities/ “The Wrong Gut Bugs Can Make You Fat and Sick (and How to Fix Them)” https://ultrawellnesscenter.com/2017/09/21/the-wrong-gut-bugs-can-make-you-fat-and-sick-and-how-to-fix-them/ “Top 5 Diet Changes for Autoimmunity” https://ultrawellnesscenter.com/2017/06/30/top-5-diet-changes-for-autoimmunity/ “Gut & Digestive Health”  https://ultrawellnesscenter.com/2012/10/17/lesson-4-gut-digestive-health/ Hosted on Acast. See acast.com/privacy for more information.

Coming up on this episode of The Doctor's Pharmacy. We always say to people, you know, get something from every color of the rainbow every day. You know, get some plant foods from every color of the rainbow every day. Hey everybody, it's Dr. Mark Hyman. Welcome to this special episode of The Doctor's Pharmacy. That's pharmacy with an F-F-A-R-M-A-C-Y, a place for conversations that matter. And I call this special episode, House Call. In this series, I'm going to sit down with my colleague and friend, the Ultra Wellness Center Physician and Medical Director, Dr. Elizabeth Boham, who's what every physician should be. She's a registered dietitian, an exercise physiologist, and an MD, which is a unicorn,

as I said before. We're going to talk about how, as functional medicine docs, we tackle specific conditions in our practice every day that's very different from how traditional medicine takes care of it. And today we're going to talk about leaky gut, which is something that is starting to be in the awareness of traditional medicine, but they still don't have a clue how to diagnose it and how to treat it. So tell us first, what is leaky gut? Yeah.

So many people are like saying the word leaky gut, leaky gut. But officially, right, the official medical term is increased intestinal permeability. And I love to draw a picture for all my patients when they come in to really show them what we mean by increased intestinal permeability. Yeah, I failed art in the eighth grade, so I just show them Google Images. I don't know. Oh, that's good. That's good.

I don't know. I'm still drawn at each time. I'll go to Google Images. That's very smart. So we know there's this one cell layer, right? There's that one cell layer of the endothelium that divides the inside of the intestine, right? So where the food is and all sorts of other things, the inside of the

intestine. Your GI tract is a tube that's literally outside of your body. Right. I mean, it's a protected tube that you put food in and all that stuff goes in and it comes out the other side. And it's literally like not really part of your body in the sense that it's... Right, the stuff inside isn't yet in your body, right? Yeah, right. But there's that cell layer that has to determine what should come into my body, right? And what shouldn't? What's been properly digested food? You know, has this protein been broken down enough yet? Should this come in?

Should I absorb this? Or should this stay out? So that barrier. It's like a filter. It's like a coffee filter. You don't want the grounds getting into your coffee, but you want the good stuff getting in. That's sort of how your gut is supposed to work. That's great. Yeah, absolutely. And when it doesn't, it's like you have holes in your coffee filter and stuff leaks through. Right. And why is that a problem? Right,

because that stuff leaking through, that might be a food particle that's not digested enough yet, or it could be a bacteria or a bug, a fungus, or something that shouldn't be getting into the body, some of the not so good bacteria. And when those things that get into the body when they're not supposed to, then they can trigger all sorts of other symptoms in the body. And that might be symptoms of inflammation. So somebody might feel like joint pain or asthma, congestion. It may trigger, and there's been a lot of studies to show this, it can trigger autoimmunity. Yeah. Right. Allergies, autoimmunity, asthma, all kinds of fibromyalgia. Yeah. But you know, what's interesting is that most diseases that are

chronic diseases are inflammatory diseases. Yes. Right? Heart disease, cancer, diabetes, Alzheimer's, stroke. I mean, these are all inflammatory diseases. Even depression is an inflammatory disease of the brain. ADD is inflammation of the brain. Autism is inflammation of the brain.

And so what's really interesting about this gut issue is that when the barrier breaks down, and you have basically like an area the size of a tennis court, if you laid your intestines out flat, and it's like one cell thick. So you're basically one cell away from a sewer on the other side. Such an important cell, right? Yeah. And that can get damaged. And when that does, things leak in, like you said, and you've got 60% of your immune system right under that layer, which then reacts to whatever's coming through that's not supposed to come through. So your body's actually doing its job creating the inflammation. It's just that your gut's leaky and the stuff getting in, you shouldn't be getting in.

Right. And then you start to not feel so good, right? Like you mentioned, fatigue or brain fog or joint pain or swelling in the body. We see a lot of people holding onto water, or swelling, or congestion, or asthma. And then that whole cycle of autoimmunity also. Yeah, so it's really one of the most prevalent problems. And so why are we having all this leaky gut?

Oh, right. That's a great question, right? And it's so much because of our crummy food supply. Oh, what do we know about that? You're listening to me. That's all I talk about. Our crummy food supply that we've been putting a bunch of, you know, pesticides and antibiotics into, which is just shifting our microbiota. Like glyphosate from the Roundup, the weed killer that's on almost all our GMO foods and even wheat products is one of the biggest damagers of your microbiome. Forget that it causes cancer, whether you can argue that or not, but it does disrupt your microbiome.

Right. And we, of course, are trying as physicians not to prescribe as much antibiotics for our patients, but so many of us have taken, unfortunately, too many antibiotics. And then our food supply, right? We're using so much antibiotics in our food supply to grow bigger cows, for example, and that's just shifting that whole microbiota in our gut. It's true, and I read a paper recently about emulsifiers in food, which is using all processed food to make it thick or solidify it, hold it together. And these emulsifiers like carrageenan and xanthan gum, and they even have this thing

called microbial transglutaminase, which is basically bacteria made gluten, if you can believe that. And the reason it's called gluten is because it's like glue. So it makes things stick together, makes the food stick together, right? But it's highly damaging to the gut. And so you've got all these processed food ingredients in food that are linked to autoimmunity, right? So it's not even, and then of course the starch and the sugar, the processed oils all damage your gut. And then, of course, the lack of fiber, the lack of phytochemicals in our diet, the lack of good foods, prebiotic foods, probiotic foods. Like I had sauerkraut for lunch yesterday.

I mean, we don't need that stuff. And it's so important, and we've seen so much damage to our gut because of all of these various factors in our diet. And then, of course, there's the acid blockers that we take for everything, the antibiotics, as you mentioned. Hormones can mess up your gut bacteria, you know, steroids can do it. And so you end up with antibiotics, obviously end up with this horrible cascade of people with gut issues. It's the number one reason people go to the doctor. We're seeing so much of it now. It's crazy, isn't it? I mean,

it's so many people are coming in with digestive issues and symptoms of inflammation in their body. But it's really common. Even if people are coming to us for other reasons, we're seeing, okay, it's the gut. We've got to start with the gut and pay attention to what's going on there. Functional medicine has been thinking about this for decades. And now there's a microbiome revolution. Everybody's talking about it.

There's huge industry development around it. Everybody we're just talking about probiotics and this and that. And we've been focusing for decades on the simple fact that most of our chronic illnesses start in the gut. Yes. And whatever the name of the problem you have, whether it's migraines or whether it's depression or whether it's diabetes or obesity. I mean, I had a guy with rheumatoid arthritis or autism or whatever. You got to start with the gut. And traditional medicine, like leaky gut is not a thing. Like you go to the doctor, if you have arthritis, you're like, how's your gut? Go to your cardiologist, how's your gut? Even though there's so much research showing the connection. You don't get trained. And so there's so much research showing the connection, right? Yeah.

We don't get trained. And so... Right. There's this huge gap right now where the science has advanced so far, but the practice hasn't. Right. And in functional medicine, we've been really great at actually getting the memo that the gut is at the center of our health.

Right. So for years, right, we've learned about that five-hour program with functional medicine and how helpful that can be to heal the digestive system and then heal all these symptoms or diseases that somebody has. Yeah. I mean, it's amazing. I was talking to the CEO of Cleveland Clinic recently and he was telling me about studies that he'd heard about that had used fecal transplants in autistic kids and taking the

poop out of a healthy kid and putting them in an autistic kid and the kid's autism goes away. It's phenomenal. I mean, that's not true for all kids with autism, but it's phenomenal. Yes. It's amazing. Or they're doing transplants from people who are thin to people who are diabetic and their blood sugar gets better. Right. I mean, I had a guy once who was a really great patient, and he was very poorly controlled diabetic on lots of medications. And we worked on his diet. It helped a lot. Took it down from like 200 to like the 120s or so.

But I never could get it all the way down. He wanted a really good diet and exercise. And he was telling me he had a bunch of digestive issues. And so I said, you know, why don't you take some charcoal and do this and do that? And he called me back. He says, I don't know what happened, but my blood sugar went to 90. Right. So we absorbed all the toxic crap in his gut that was causing inflammation, that was causing his blood sugar imbalance. And these are the kinds of things that we do every day in functional medicine, but that are not part of traditional care and people are missing out on.

Right, right. When we're saying, why is this going on? How do we get to that underlying root cause for that individual person? Hi, everyone. Hope you're enjoying the episode. Before we continue, we have a quick message from Dr. Mark Hyman about his new company, Pharmacy, and their first product, the 10-Day Reset. Hey, it's Dr. Hyman. Do you have FLC? What's FLC? It's when you feel like crap. It's a problem that so many people suffer from and often have no idea that it's not normal or that you can fix it. I mean, you know the feeling. It's when you're super sluggish, your digestion's off, you can't think clearly, or you have

brain fog, or you just feel run down. Can you relate? I know most people can. But the real question is, what the heck do we do about it? Well, I hate to break the news, but there's no magic bullet. FLC isn't caused by one single thing, so there's not one single solution. However, there is a systems-based approach, a way to tackle the multiple root factors that contribute to FLC. And I call that system the 10-Day Reset. The 10-Day Reset combines

food, key lifestyle habits, and targeted supplements to address FLC straight on. It's a protocol that I've used with thousands of my community members to help them get their health back on track. It's not a magic bullet. It's not a quick fix. It's a system that works. If you want to learn more and get your health back on track, click on the button below or visit GetPharmacy.com. That's GetPharmacy with an F, F-A-R-M-A-C-Y.com. Now back to this week's episode. So you've got some amazing cases. And I think I'd like to sort of get into it because

people don't understand how so many of our issues come from the gut and how easy it is to diagnose it and treat it. And we use tests that traditional doctors just don't do. Like we have a different set of lenses, a different set of filters that we can sort through information and data and ask questions that traditional doctors can't. Like, how do you measure a leaky gut? How do you look at the microbiome in the gut? How do you look at the digestive function in the gut? How do you actually start to treat it in a different way? And I think your first case is just so rich with a story that is so common that I just love you to share this because I think everybody's going to resonate with this story. And by the way, I've never seen this patient as your patient, but I've literally seen the same story a hundred times or maybe 500

times or a thousand times in my bracket. It's so common. It's the same freaking story. Right. So tell us about this person. So it was a 24-year-old gentleman who came in to see me and was really struggling over the last year with his digestive system.

He was having a lot of bloating and gas, pain in his stomach. Every time he ate, he was having diarrhea and sometimes he was getting constipated. And he went to his traditional GI doctor and they told him you have irritable bowel. But he wasn't getting any better, right? And he was just really, he was, because he was having so much stomach pain, he had lost some weight. So he wasn't, you know, he was on the thin side to begin with, but because he was having stomach pain when he ate, he wasn't able to eat as much and he was even losing more weight. He was feeling really weak and tired and sad, depressed, right? And so for him, the time, well for everyone, the timeline is so important, right? That's what we learn in functional medicine is gathering that information,

learning about that individual patient's story, seeing their timeline. We start with a history with the mother and her pregnancy and the birth and whether they breastfed and whether they took antibiotics, whether they were sick as a kid, what happened, when they were introduced to food, when they got gluten, when they got dairy. We ask all these questions. So when someone comes in with irritable bowel, the average GI guy is not asking all these questions. Right.

So why do we ask all those questions? So, you know, because for this gentleman, for example, you know, he really didn't have stomach pain before a year ago. But what we found out is that when he was a kid, he had ear infections. Probably because he was eating dairy. Probably, right? So it's such a common connection. I remember once being in the ER, Liz, and this patient came in

and this little boy was coming back, like a toddler was coming back over and over to the ER with ear infections and just so inflamed. And I said, how was he? Like, did you breastfeed? Yeah. So when did he start getting ear infections?

Well, we started formula and dairy and milk. And I'm like, oh, okay. And this was even before I knew about functional medicine. I know. And I was like, well, maybe you shouldn't eat dairy. Yeah. And the kid was fine, you know? Right.

That's such a common connection. I mean, even my son, when he started dairy, he got asthma and eczema. It's unfortunately such a common connection. So for this child, he had a lot of ear infections and eczema. And so he was on antibiotics about once or twice a year in his childhood. And he really didn't think that was very much. He's like, that's not, you know, that wasn't too much. But, you know, it makes a huge impact on the microbiome as we're learning. And then he started to have acne as a teenager, maybe because of dairy more, right? Or some of

the imbalances in the microbiome, right? When you screw up the gut with antibiotics or a C-section or lack of breastfeeding, then you get often more acne. And we treat acne from the top in in as opposed to the inside out, which is actually where it works much better. And this gentleman was given low-dose antibiotics for two years. So then he took even more antibiotics. And so this history of antibiotics sort of set him up. And about a year ago, he had some sort of stomach bug. So some probably viral stomach infection. And then since that time, he started to have all these digestive issues and was losing weight. And so... Which is a common story. People are... So common, like you said.

This sort of smoldering a bunch of insults over the course of their life. You know, maybe they're a C-section. They had antibiotics as a kid. They took acne antibiotics. They got, you know, they were eating a crappy diet, whatever. And then all of a sudden something happens and then boom, the body can't take it anymore and it creates some kind of disease. But if you look at the story, you can often map out exactly how this happened. That connection with his acne, with his asthma, with his digestive issues, with those antibiotics, that's that story we often see. And we're not making this up. There's so much science that shows

that your gut microbiome plays a role in acne and eczema and asthma. I mean, we're actually doing this at Cleveland Clinic now. We're studying asthma and looking at how the microbiome plays a role and how it affects inflammation, all these various factors that most doctors just don't pay attention to. Right, so with him, as we do with most of our patients,

we do food first, right? So we said, okay, we've got to really focus on this person's diet and help him start feeling better right away so he can start to eat more and regain some of his strength. So we pulled away inflammatory foods. We took them off of gluten and dairy while we were waiting for tests to come back. Sometimes we will do some tests that look at, of course, we'll test for celiac disease. Which is a big cause of leaky gut. Yep, that's for sure.

Probably the number one. And he didn't have that. By the way, you don't have to have celiac disease to actually have a problem, right? You can have what they call non-celiac gluten sensitivity. I would estimate it probably affects 20% of the population. And I think if you look at the antibody levels, you can get a clue, which most doctors don't look at. And I read a study that autistic kids and schizophrenic patients often have, 20% of them

have antibodies to gluten. And it may not be full-blown celiac. Absolutely. And even, you know, regardless of, even if people are negative totally for celiac, if they have increased intestinal permeability, they start reacting to a lot of different foods. Yeah. So then you start to see with that leaky gut, as we talked about before, right, the coffee filter and things are coming through, then the body's reacting to lots of foods that it maybe never reacted to before. So they're not true allergies, They're more like sensitivities. Sensitivities.

And because of, and the real thing is it's because of this increased intestinal permeability. So our job is we have to heal that increased intestinal permeability so that they don't have to be so restrictive with their foods. I mean, we still always want them to be on a healthy diet, but we want to relax those restrictions over time. Most of the time we can. Yeah. And so as part of the approach of functional medicine, we start them on the elimination diet. So eliminating all the inflammatory foods, gluten, dairy, processed foods, all that stuff. And then you-

Remove, right? That's the remove in the 5R. Right. The 5R is remove, replace, re-inoculate, repair, and rebalance. And we'll go into each of those because they're really important. But the next step is also there's other things we may need to remove. There's tests we need to do. Yes. So what kind of tests would you look at as a functional medicine doctor that you wouldn't see at a traditional doctor's office

that give us a roadmap of how to treat these patients? Right. So we did a stool test that looked at his microbiome. And what we noticed is that there was an overgrowth of unhealthy bacteria and unhealthy yeast. So he had this, you know, probably because of years of antibiotics, he developed this dysbiosis,

this imbalance in the bacteria and yeast. And so there was an overgrowth of the unhealthy things. It's like weeds, having a lot of weeds in your garden, right? Yeah, right. It's not always like one of those, you think of a stomach infection and you're getting really, really sick, you're throwing up or having diarrhea. It's an imbalance and it's called dysbiosis, but that imbalance causes a lot of symptoms in people. When you have the wrong bacteria and the wrong yeast levels, you know, you can get a lot of bloating after you eat, you can get a lot of fatigue after you eat, you can get

those symptoms of constipation and diarrhea and that causes this inflammation in the digestive system so all of your digestive enzymes don't work well. So you're not breaking down your food well, you're not absorbing your nutrients well, and it becomes this vicious cycle that people are dealing with and we see all the time. Yeah, it's so powerful. So when I see this patient, I'm like, okay, you don't have to do all the tests, but sometimes when you get stuck, you look at various tests that look at antibodies against things that are in the gut that determine a leaky gut. We call it Cyrex-2 testing, which is a test you can get through functional medicine doctors. You can test to see if there's leaky gut.

I love that test, too, because it's a great way for us to follow up and see how much we're seeing improvement. Are we doing enough? Are we seeing improvement in their leaky gut or increased intestinal permeability? And then we look at poop testing, like where we do thousands and thousands of these tests. And it's so helpful. And it doesn't just look at the microbiome. It actually looks at the function of the gut. Yes.

Like whether there's malabsorption, whether you have no digestive enzymes, whether there's inflammation, whether there's overactive antibodies in there, whether you have imbalances in what we call the short chain fats, which are the food for the colon that are produced by bacteria eating the right kinds of fiber. And if they're low, it means there's an imbalance. Then we look at the microbiome and we look at what grows, we look at parasites. And then we target and micro target the things that are out of balance for that person. And it's different for everybody. And we might look at food sensitivity testing. We might look at, at, and even things like heavy metals or other things, which can also cause it. I had a patient with ulcerative colitis once and I did everything right. I did the whole five R it wasn't working,

but I forgot the first part of the R, which was remove. And I thought, well, maybe, you know, heavy metals can cause autoimmunity. Maybe it's's a problem and so I tested him and he was like wasted away and he was like it was terrible he actually had high levels of mercury we treated mercury and his colitis went away so it's phenomenal yeah so I think it's it's so powerful this case is so important because it really describes how a patient you know goes to the traditional doctor is diagnosed with a disease irritable bowel syndrome by the way anytime hear syndrome, it means doctors know what the heck's going on. It's just a collection of symptoms that we agree we're going to put in this bucket. And if you have those symptoms, you have this disease, but it's not really a disease. And so that's what functional

medicine is. It sort of looks upstream to figure out what the root causes are and personalize the treatment for everybody. And there's common things that we do, like the 5R, but it may be different R's for each patient, right? Right, right. So for him, we removed the inflammatory foods and we removed the bacteria and yeast. I actually treated him with an antibiotic, a non-absorbed antibiotic and an antifungal.

So I treated him with prescription medication. Yeah, weed killer. So that was the remove, right? And then the replace because he was underweight and because of that inflammation in his digestive system, I gave him some digestive enzymes for a short period of time just to help him to help it so the food wasn't as inflammatory for him and to help him absorb more nutrients. And then we worked on re-inoculating, right? So after we gave him some good probiotics. Put in the healthy bacteria. Put in the healthy bacteria.

Some good prebiotics, right? So we know that there's... What are prebiotics? Prebiotics are the things that help feed the good bacteria. So they're the food for the probiotics. Which is usually what? Like fibers. Fibers are amazing prebiotics. We know a lot of phytonutrients are prebiotics. So this, I think,

is really exciting research when we're looking at our phytonutrients. What are phytonutrients? Right. I know. It's amazing, right? So our food has minerals in it. It has vitamins. But it also has these things called phytonutrients, which are these components in our plant foods that have this amazing health benefits for us. So that can include things like ellagic acid that we see in pomegranate that can feed some of the good bacteria, that acromantia that we know can lower inflammation. We know that... Just to back up on that acromantia thing. So when we look at the poop, we can tell if there's like good levels of different bugs.

One of them we look at is acromantia. And it turns out that that is so important for protecting your gut. It helps you keep your biofilm or that little coating over the gut so you don't have a leaky gut. And it's involved in so many autoimmune diseases and response to cancer therapy and metabolic issues and weight. And it's such an overlooked thing. And you can't take a probiotic of it, at least not yet. Right. But you can feed it the good guys. We can feed it.

We can feed it with all these amazing phytonutrients like what's in pomegranate, the ellagic acid. And also we know that sulforaphane from our cruciferous vegetables feeds the good bacteria, you know. So broccoli, collards, kale, but not juicing. Right. Brussels sprouts, all those good ones. We know that green tea, you know, that has good phytonutrients in it that's good for the digestive system. So we always say to people, you know, get something from every color of the rainbow every day. You know, get some plant foods

from every color of the rainbow every day. Get some good red foods like the pomegranate or cranberry. Get something orange and yellow and green, blue, purple, white, tan. You know, all those good, healthy plant foods that we, you know, like our vegetables, our fruits, our spices, our teas, our coffees, really actually are impacting our microbiome, which is fascinating.

It's so great. And just a great anecdote from a colleague of mine, Dr. Lee, who was on our podcast talking about eat to beat disease. His mother had stage four uterine cancer. And being the smart doc he is, he understood from the research that if you have low acromantia, patients don't respond to the immunotherapy, what they call the checkpoint inhibitors, which is this new form of cancer therapy that helps activate your immune system. So if your gut isn't healthy, you can't actually get the cancer cells to die with the immunotherapy. Right. So basically you die unless you have good bacteria in your gut. And so his mother had stage four uterine cancer and was going to die and wasn't responding. And he gave her

pomegranate, cranberry, green tea, all these phytochemicals, got her acromantia levels up, and she was cured of her stage four cancer within a month. That's a phenomenal story. It's an incredible story. And I think that just shows the power of the plant foods and of getting focused on the gut. Yes. Yes. You know, we call it the 5R. I call it the weeding, seeding, and feeding program. So you weed out the bad things, you seed it with the good things, and you feed it with good nutrients and all that stuff.

So it's really, it's so powerful. I can't tell you, you know, as a functional medicine doctor for the last 30 years, and you've been doing this almost as long, the results you get from focusing on the gut with so many conditions, whether it's autoimmune or whether it's allergic, whether it's digestive, whether it's your skin issues like acne, eczema, whether it's your mood, whether it's weight metabolism, whether it's weight, metabolism, whether it's migraines, whether it's Alzheimer's, I mean, autism, ADD. It's just amazing when you start to focus on this.

So let's break down the five-hour program for everybody. So we got the remove. So what are we looking at? We're removing unhealthy foods or inflammatory foods for that person. So they can be food sensitivities, things like gluten and dairy, the big ones. Food allergies, food sensitivities, yeah. And then we're removing- Processed food and junk food, right? That's for sure. And sugars and excess sugar, which is feeding the wrong bacteria. And then we're removing the unhealthy bugs or yeasts or viruses. Human bacterial overgrowth, yeast overgrowth, a parasite.

You know, I was on the Red Table talk and Jada and her son both had parasites and they both had gut issues for a long, long time. Right. And they thought it was just how they were. But with, you know, short little course of treatment, they were both, I've never felt better. Right. And all the other symptoms. Because now you're actually absorbing the nutrients you're eating, which just helps the

body heal. Yeah. So then, so you remove. Then we replace. But you might also remove things like heavy metals or stress or toxic people in your life or whatever's giving you a stomach problem. Right, right, right. Replace means just to replace some of those digestive enzymes if needed. Reinoculate. So the replace also could be like prebiotics, right? So putting in the fibers to feed the gut and to actually maybe use hydrochloric acid sometimes for people who aren't digesting their food as they get older. Yeah, and to help get them off of the acid blockers, which we know are creating a lot of problems

because we need that acid in our stomach to digest our food. Let's take a little detour. So you just mentioned acid blockers. These are among the most prevalent drugs prescribed today in America. And statins, I think. When I was in medical school in the 80s, we just had those drugs come on the market. The drug reps used to come to us and say these are very powerful drugs never use them for more than six weeks because they block stomach

acid and they'll cause significant problems if you do that long term right you can cure an ulcer with it you can fix an acute problem but never use this now people are on this for decades yes and it and and the the side effect which is listed in the in the manuals that we get as doctors, is that it causes irritable bowel syndrome. So you end up fixing the heartburn, but you get irritable bowel and bloating and bacterial overgrowth and all these problems. Right, because you need the acid in your stomach. And when you block that acid, then there can be an overgrowth of bacteria

where there's not supposed to be, And that can cause all those slow problems. You also get more yeast issues and all this stuff. And then you don't, you're not absorbing your minerals so you can get osteoporosis and you're not absorbing your B12 so you can get fatigue and dementia, right? It just goes on and on and on. You don't absorb zinc and magnesium,

minerals, calcium, you cause osteoporosis, pneumonia. It causes, you know, um, it goes on and on, right? It's so it's, and it's, it takes osteoporosis, pneumonia, it causes, you know, irritable bowel. It goes on and on, right?

Yeah. It's so, and it takes some work sometimes. When people have been on an acid blocker for a long time, it takes some work for us to help wean them off because their body has gotten pretty used to it. They start to get, their body wants to make acid, so it's working against the medicine. So when you wean them down, sometimes they get more acid production. It's called rebound. So you actually, it's like, and it's sort of a trick. Like you get off it, but it makes you worse.

So you feel like you have to get back on it. But it's actually not true. And you can actually get off it. Absolutely. So we do that all the time. We do it all the time. So re-inoculate, giving all the good prebiotics and probiotics, the good bacteria and all the things that feed the good

bacteria. And then the fourth R is repair. How do you know what probiotics to take? Oh, that's a great question. I want to know, what do you prescribe? Oh my goodness. That goes on and on. We could talk about that for the next hour. Yes, it's true. Right? There's more and more probiotics on the market every day and all have different roles and different functions. And we're just sort of, honestly, I think, you know, we've been doing this forever, but it feels to me like we're at the infancy of this understanding of how to use these in medicine. Yeah. I mean, there's some great brands that I trust and I use all the time, but when somebody

is, you know, doesn't maybe know what to do, I'll say, you know, get one get go to a reputable place reputable pharmacy or a good wellness store pharmacy and And get a probiotic, you know, try it if it makes you feel worse then stop it You know because there's some there's some good bacteria that make people feel worse You have bad bugs growing in there and you put the good bugs in there they have a fight Yeah, and they cause and so that means we just have to do more work before we can start it They have bacterial overgrowth. Exactly. If you have bad bugs growing in there and you put the good bugs in there, they have a fight. And they cause lots of bloating. And so that means we just have to do more work before we can start it. Yeah.

So. So you got to re-inoculate and then you got the. And then repair. Yeah. And that's the fourth R. So that's things like, that's like giving good protein, good amino acids, which are the building blocks of protein. To repair. Yeah.

To help repair that barrier, that coffee filter, right? We have to repair it with good protein. And sometimes we'll use amino acids like glutamine that help repair it. We'll give more zinc, whether it's from food sources or as a supplement. Maybe we'll give some vitamin A, which also helps with healing that barrier. It helps with healing the endothelium in the gut. So those are things we will do to repair. And then rebalance, right? That's the fifth R, which is really focused on managing our stress and how we're reacting

to the world. Because we know that when our parasympathetic nervous system is engaged, when that calming nervous system is engaged through meditation that calming nervous system is engaged through meditation and yoga and breath work, that our body has the ability to heal. And it heals better when our body is at rest. I mean, yeah, you just touched on something very powerful, which is that our gut and our brain are connected. There's a whole hard wiring of nervous system and our gut even has this independent nervous system that actually is like a second brain. And so, you know, we often say people are irritable bowel, are emotional or anxious or have,

you know, just maladaptive emotional coping mechanisms. But it turns out that the irritable bowel actually can cause an irritable brain and lead to anxiety and all these emotional issues. So it's bidirectional, and I think that's a great lever for helping people reset their gut. Absolutely. You know, I just want to share a story because I've been doing this for a long time, and of course my, my, I don't know what it is, curse or blessing, depending on how you look at it, is actually getting really sick and having to figure out what to do to fix myself. And I've had a lot of gut issues over the years, which is why I really focused on this.

The first was when I had mercury poisoning. And I tried everything. I did every functional medicine trick in the book back then, and it wasn't working. And until I got the mercury out, which disrupts all your enzymes, it disrupts your gut, it causes leaky gut, it causes yeast overgrowth, it screws up the bacteria in your gut. Until I got rid of the mercury from my system, I couldn't get my gut straight. Yeah. Because it's impacting your immune system too, right? Right. And then I, many years later, I kind of got an issue which was triggered by an antibiotic for a root canal that I had to take called clindamycin,

which is known to cause C. diff, which is a terrible bacterial infection that kills like 30,000 people a year. And I got that. And I was so sick. I remember. And Liz would come over to my house and I was like, it was pretty bad. I'm like, we're all struggling to figure it out. And I had mold in my house and all these other things. But I ended up having colitis.

And I had tremendous leaky gut. And I did my own stool test. And my friend Patrick Hannaway, who worked for the stool test company for many years, my colleague at Cleveland Clinic, he and I looked at my stool test. And we probably, between the two of us, seen like 20,000 stool tests. We're like, this is the worst one we've ever seen. And everything was screwed up. And I had no good bacteria. I had low butyrate. I was not digesting. I had tons of inflammation. It was terrible. And I couldn't really fix it using a lot of the traditional things. And then I started to sort of work on a

gut shake, which included a lot of the sort of 5R concepts, right? So I cleaned up my diet, obviously, I got rid of the bad bugs, but I used a combination of these polyphenols from the plants, a pomegranate, cranberry, green tea, also added, you know, glutamine, I added prebiotics, probiotics, I even added colostrum, you know, which is to help regulate the immune system. And it was like a miracle. I had went from full blown colitis to like normal in three weeks. And I've been great ever since. And, you know, it's just like, wow, this is something that people can actually do. It's not that hard. It's not drugs. And the alternatives are like really bad

drugs. Right. So, you know, we want to go to the next case, which was sort of not about people with a gut-centric issue because people often think, oh, well, if I have a leaky gut or if I have gut-related problems, I'm going to know it. My stomach's not going to be right. I'm going to feel symptoms. But it's not always the case. So the first case was a guy who did have a typical history of antibiotics and acne and some infection and then diet and all this stuff. And that was pretty clear. But there are many cases where people come in and they have zero gut symptoms, but their gut's a mess and it's causing all these issues. So tell us about your next case of this patient with an autoimmune

disease. Right. So this was a 50-year-old woman who came in and she didn't have any real digestive issues that she was paying attention to or that were bothering her. What was bothering her were her joints. So she was having a lot of joint pain, especially in her hands. And she was starting to get a lot of swelling and deformity. And she was diagnosed with rheumatoid arthritis. Really common. Yep. And her, a rheumatologist wanted to put her on a biologic medication. He wanted to start her on Embril. So by the way, these are drugs that suppress your immune system

that can cause life-threatening infections and increase risk for cancer that cost 50,000 a year. So it's not risk-free and it's super costly and it can save lives and it can be a great rescue medicine if people need it. But most of the time using functional medicine, not all the time, but most of the time you can figure out the puzzle of why they're sick and fix that and then they get better and they don't need the medication. Right. And she wanted to try it a different way. So she

came to see us and said, you know what, before I go on this medication, can we do it a different way? Can my body heal? And can I get to the point where I don't need this medication? And so we did a lot of testing on her. And what we found- And by the way, the testing can sometimes be expensive, but it's a lot cheaper than a lifelong course of these medicines and the suffering that goes along with it. So if you have to spend a few thousand dollars up front to figure it out, you can stop having to pay 50 grand a year for the medication for the rest of your life. And you feel so much better. Yeah. And so we found out that she had increased intestinal permeability. We did that test that you were mentioning earlier, that Cyrex-2, which looks at antibodies against different proteins in the digestive system. And

if they're elevated, it gives us an indication that there's that increased intestinal permeability. And hers was really, really high. Yeah. And she had no symptoms. No. And she had no symptoms, right? And one of the markers on there was high that makes me also think, okay, is there really a gluten issue for this person? Because we know that that can damage, as you were mentioning earlier, that for people with celiac disease, that really can damage those villi in the intestines and is a major cause for leaky gut. Well, just that's an interesting point.

You bring up gluten. So even if you don't have celiac, you can still have issues. And one of our functional medicine faculty, Dr. Alessio Fasano, is one of the world's experts on leaky gut and gluten. Yep. And he discovered this because he found that in cholera, when there's a mechanism in the body that actually causes you to have a leaky gut and sort of get rid of the infection. And it can kill people if it's bad enough.

But he realized that the same thing that gets activated in cholera, something called zonulin, is activated by gluten. So gluten causes this protein to be produced that creates a leaky gut. And you don't actually have to have celiac. And you could even have what we call non-cell mediated immune response, which is the old ancient immune system that doesn't even use antibodies. So you can't even measure it or test it. Right. Just inflammation. Just inflammation. It's like the difference between a smart bomb and carpet bombing. It's like sort of an ancient part of the immune system just reacts and gets pissed off and inflamed. And that can cause a leaky gut. So when people have high zonulin levels or create antibodies to zonulin,

it's meaning there's some issue with the gluten. Yes, yes. And so, you know, we said when we saw her intestinal permeability test, we said, okay, we've really got to focus on these five R's with you. And we went on to find also a bacterial overgrowth. We found a bacterial overgrowth in her digestive system. And we found a bacterial overgrowth in her digestive system, and we found a bacterial overgrowth in her mouth. So we know that. There's been really interesting studies showing that when there's certain bacteria in the oral cavity that have been associated with autoimmune disease.

So gingivitis or inflammation in the gums from a bacterial overgrowth has been associated with autoimmune disease in some people. And I think for her, we saw that connection because we saw some elevated levels of unwanted bacteria in her mouth. And we saw some unwanted bacteria in her digestive system. What does she need, like mouthwash? Dental care? Yeah. I mean, you can treat the um bacterial overgrowth in the mouth you can treat it with certain types of dental care scaling and root planning um we also used a a herbal she wanted to go the whole herbal route so we we used an herbal um rinse for her mouth and herbal toothpaste and an herbal rinse that

helps get rid of the overgrowth of unwanted bacteria. We use some good probiotics that you actually chew and that they give back good... Mouth probiotics. Mouth probiotics, yeah. And we used, we also used an herbal regimen that for the digestive system to get rid of that bacterial overgrowth because what they're learning, right, is that there's certain bacteria that when they cross into the body when they're not supposed to, they trigger the immune system and they trigger this autoimmune process and they trigger that inflammation and then the body gets confused

and it starts fighting off, you know, its joint space when it's not supposed to. Yeah, and there may be genetics like the gene, I think it's DR4 or something, which is associated with increased susceptibility to rheumatoid arthritis in the face of certain gut infections. And we know this from medicine. We were trained in medical school that if you have certain bacteria, like Yersinia, you can get arthritis. Or if you have Entamoeba histolytica, which is a parasite, you can get rheumatoid arthritis. So we learn this as traditional medicine doctors, but we sort of don't pay attention to the fact that it may be more broad than that. And I think, you know, you also mentioned the overgrowth of bacteria. So I think people might be wondering, well, isn't there a ton of bacteria in your gut

anyway? What's the big deal? Right. So, but there's some bacteria that are good. I mean, we can put them in the category of good and some that we don't think are as good, and that have been associated with inflammation in the body and autoimmunity. So it's really, it's all about balance, right? It's all about balance. And sometimes the bacteria can go where they're not supposed to go, right? Absolutely. So like the small intestine is where you get most of the leaky gut, and what happens is sometimes those bacteria that shouldn't be there kind of migrate up into the small intestine, which is like 22 feet, and then start to grow. And then when you eat them, sorry, when you eat certain foods,

it causes that food to ferment because the bacteria is there. That's where you get the food baby and the bloating and the distension. And that's a big clue for people. If you have bloating after eating. Yes, that is a big clue. You know, it's not normal. You should not know you have a digestive system. Right. Until like two minutes before you have to go to the bathroom. You go to the bathroom in five minutes or less and you're done. That's it. Like, but people don't realize that, you know, the constipation, the bloating, the weird bowel movements, the diarrhea, the irritable bowel.

It's so common. Yeah. So for this woman, we did, of course, the 5R program. We removed gluten. We removed those bacteria. We used an herbal protocol. And then we re-inoculated, right? We gave a lot of the good bacteria, the pre and probiotics, and we did a lot of nutrients just to help her body heal, right? The vitamin A, the zinc, the colostrum you mentioned before,

and really worked with her to help with managing her stress. you know she was able to avoid the biologic medication her joints got better her joints got better her energy got better um the inflammation in her body went down she actually lost a bunch of weight as you know you know as a side effect she was happy with that side effect yeah it's a good side effect yeah she that she was happy with that so she really got much better so it was it was exciting to see And we see this all across the board. When we start focusing on the gut and the leaky gut, whether it's allergies or asthma or migraines or autoimmune diseases or plight, I mean, it's just, it's amazing how powerful it is. And this is the one thing that functional medicine is focused on that traditional medicine is almost uniquely ignored.

I remember when I was at Canyon Ranch probably 25 years ago, and I was talking to a bunch of doctors. They were guests there, and we were having a dinner. And I started talking about Leibniz gut, and there was an allergist there. And she's like, that is just such garbage and nonsense. It's not true. But now it's not true. But now it's really different.

And now there's enormous amounts of research going on about the gut microbiome and about leaky gut. And now they're looking at treating in the ICU. And it's like, wow, we've really taken a huge turn in the last 30 years. Right, right, right. It's really great. But I think, again, if you're suffering from any kind of inflammatory issue, if you're having any kind of cognitive behavioral mood issue, if you're struggling with any kind of sinus or allergy stuff or any gut stuff, you've got to find a doctor who really understands how to work with the gut in a

way. And the truth is, it's not that hard. It's like once you figure it out and how to navigate, but we need to sort of just review what we talked about because it's so compelling hard. It's like once you figure it out and how to navigate, but we need to sort of just review what we talked about because it's so compelling. And I think that most people don't really grapple with this idea, but that leaky gut is a thing, that it causes a whole range of conditions we just talked about. The traditional medicine ignores it, but there's really great tests for it, right? There's really great tests to look at food sensitivities, at your microbiome, and your gut, and all the factors, overgrowth of bacteria, yeast, parasites, that'll tell you exactly what you need to do. And then you use functional medicine to fix the problem using this 5R

approach, which we kind of went through with these patients. And even diabetes is caused by leaky gut, right? Because the metabolic toxins get in the system and anything that drives inflammation causes weight gain. Right. Those lipopolysaccharides, right? Right. They've been tied. And there's a whole like a lot of science about this. So it's pretty exciting.

And then people can start to change what they're eating to include more prebiotic foods, to include probiotic foods, to more fiber foods, more phytochemicals and phytonutrients. They can do things to help their gut repair using enzymes or prebiotics and using gut repair nutrients like we talked about, vitamin A, C. So all the, sorry, vitamin A, D, and gluten, sorry, glutamine, not gluten, and zinc. And that really is an incredible roadmap for people to heal their gut and to heal all these chronic conditions. And this is what we do at the Ultra Wellness Center day in and day out. We've been doing it for 25 years together,

15 years at the Ultra Wellness Center. And I think I just want people to understand that they don't have to just suffer. People just suffer needlessly when there are ways to heal these problems that are quite different from what you get in traditional medicine. And that's what we do at the Ultra Wellness Center in Lenox, Massachusetts. We have four incredible doctors, two PAs. Well, I'm one of the doctors. I can't call myself incredible, but I think I'm okay. I think I do all right.

And we have an incredible team of nutritionists. And we see people from all over the world to deal with these chronic issues. And we'd love to welcome you there. You go to drhyman.com forward slash UWC. That's for Ultra You go to drhyman.com forward slash UWC, that's for Ultra Wellness Center, drhyman.com forward slash UWC. So it's been great having you, Liz, on this week's house call of the doctor's pharmacy. I really love the conversation. It's just so deep and beautiful, and I hope people get something out of it. If you enjoyed this mini-sode of the doctor's pharmacy, share with your friends and family on social media, subscribe wherever you get your podcasts, leave a comment. I'd love to hear from you. And we'll see you next time on The Doctor's Pharmacy.

Thank you, Mark. Hi, everyone. I hope you enjoyed this week's episode. Just a reminder that this podcast is for educational purposes only. This podcast is not a substitute for professional care by a doctor or other qualified medical professional. This podcast is provided on the understanding that it does not constitute medical or other professional advice or services. If you're looking for help in your journey, seek out a qualified medical practitioner. If you're looking for a functional medicine practitioner, you can visit ifm.org and search their Find a Practitioner database. It's important that you have someone in your corner who's trained, who's a licensed healthcare practitioner, and can help you make changes, especially when it comes to your health.