The Dr. Hyman Show - What We Got Wrong About the Gut Microbiome (And What's Actually Right)

Episode Date: September 2, 2026

We hear a lot about improving gut health through food, probiotics, and supplements. But after more than a decade of major advances in microbiome research, the picture has become both more promising and more complex. In this episode, I’m joined by gastroenterologist and neuroscientist Dr. Emeran Mayer, co-author of the new book The Mayer Model, to explore how our understanding of the gut-brain connection has evolved—and what we may still be getting wrong. We also look at what this growing field could mean for chronic disease and healthy aging. Here’s what you’ll learn: How your gut microbiome communicates with your brain, immune system, hormones, and metabolism Why diet alone may not be enough to improve gut health—and how sleep, stress, exercise, relationships, and purpose also shape your microbiome How modern diets and lifestyles have created a mismatch between our microbes and human biology Why probiotics and microbiome testing may not provide the personalized answers many people expect How fiber, polyphenols, fermented foods, and greater plant diversity help support a healthier, more resilient microbiome The food we eat matters, but so do the ways we move, sleep, manage stress, and connect with others. Supporting gut health isn’t about finding one magic solution. It’s about creating a healthier, more resilient system over time. Beginning September 1, Dr. Mayer’s team is offering my audience a collection of bonuses to accompany The Mayer Model. To learn more about the book and access the bonuses, click here. View Show Notes From This Episode Sign up for Dr. Hyman’s Brainshaping Academy to learn how to nourish the biological systems that support your mental, emotional, and cognitive health https://drhyman.com/products/brainshaping?utm_source=dr_hyman_show&utm_medium=newsletter&utm_campaign=may_27&utm_content=link Get Free Weekly Health Tips from Dr. Hyman https://drhyman.com/pages/picks?utm_campaign=shownotes&utm_medium=banner&utm_source=podcast Sign Up for Dr. Hyman’s Weekly Longevity Journal https://drhyman.com/pages/longevity?utm_campaign=shownotes&utm_medium=banner&utm_source=podcast Join the 10-Day Detox to Reset Your Health https://drhyman.com/pages/10-day-detox Join the Hyman Hive for Expert Support and Real Results https://drhyman.com/pages/hyman-hive This episode is brought to you by Seed, Seatopia, Made In, PerfectAmino, BON CHARGE, and BIOptimizers. Make your microbiome part of your daily routine with seed.com/hyman and save 25% with code 25HYMAN. Find a cleaner source of seafood. Check out seatopia.fish and use code HYMAN for free shipping on your first order. Explore kitchen essentials at madeincookware.com and save 10% off your first order with code HYMAN-HIVE. Explore red light products at boncharge.com/hyman and enjoy 15% off with code HYMAN. Help fill protein gaps at bodyhealth.com and use code HYMAN20 for 20% off. Shop Magnesium Breakthrough at bioptimizers.com/hyman and save 15% with code HYMAN.

But I think to see the microbiome as a master translator in our bodies, that translates whatever goes on around us, comes into the diet, and which comes to us through our mind, because that goes down to the microbes as well. The microbes translate this information into the body's own language. And if that translation has an end result of a pro-inflammatory neurodegenerative message, then that's what the disease comes in. Bloading, gas, irregularity are often brushed off, as minor issues, but they can really interfere with your quality of life. I see this all the time

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It's good to have you back. Thanks for inviting me. Mark, it's a pleasure. Honor. Well, it's fun to talk about poop, which is my favorite subject. They used to call me Dr. See Every Poop when I was at Canyon Ranch because I used to look at stool. test all the time and I wanted to see stool tests on every patient. But you're, you're an MD,

your gastrologist, you're a scientist, you've been studying the microbiome for a long time. And, you know, you've written a book about it that we talked about on a previous podcast, which I recommend people listen to, the mind gut connection, a really powerful book. This is sort of a 10th anniversary edition that's come out, how hidden conversations within our bodies impact our mood, our choices, and our raw health. And I think, you know, science has finally caught up with a simple idea that was happening in your gut. is affecting every single system in your body and is related to almost every disease you can think of, whether it's depression or dementia, whether it's cancer or heart disease, whether it's diabetes

or multiple sclerosis. Everything in some way or another has a tieback to the microbiome in the gut. And even, you know, this whole new nutritional medical psychiatry field has emerged since then. I think systems biology is now coming more into the forefront of understanding the bodies as complex network of systems, not is structured organ-based medicine that we have. It's based on specialties that has nothing to do with actually how the body works. It's just an artifact of basalias dissecting the body. So now we're kind of in this field like, well, what do we know about the microbiome now? What can we do to assess it properly? And how do we actually treat people focus on the microbiome? And a lot of your work is about this in your new book, which is really an incredible manual. It's more

like a practice band called the mayor model, optimize your health and wellness with the brain gut connection is out now. It's is a really good, like, practical application of this and understanding how we can bring our healthy microbiome back into gear. So maybe we can start out by having you kind of frame just a scope of the problem. Again, like how big is a problem of the microbiome in health and chronic disease in 2026, particularly in America? Yeah, I would say, I mean, just building on what you elegantly summarized, you know, that we're changing our view of looking at these interacting systems. It's not just the microbiome. It's not a particular microorganism. It's really the system in which these elements interact with each other. I think that, so I've kind of,

you know, from the initial enthusiasm 10 years ago, when these first papers came out about how in mouse models, how changes in the microbiome can alter emotion-like behavior, which I've questioned because we've done decades of research on these braingoth interactions without the microbiome and had a pretty good idea of how they work. So I went to my initial skepticism to, you know, jumped on the bandwagon, was totally enthusiastic. This is going to explain everything, and we can cure all our, chronic, non-contagious diseases with manipulating the microbiome. And I've kind of come back to a much more careful view of this, you know, that the microbiome

is a, we have a lot of evidence from animal studies that there is a causal relationship between what the microbes actually do and what the result is. We don't have that evidence, the same evidence in humans, unfortunately. You know, we still have to rely on correlations, epidemiological. correlations. And so I like to keep my skepticism in terms of, you know, can we actually deal with this with our health crisis just focusing on the microbiome? You know, can we just tell people to take this or this probiotic or symbiotic? I just don't think it's as simple as that. And the reason I'm saying this is because if you look at reality, you know, there's so many people like

topic of longevity. A lot of people live into their become centenarians, living to their hundreds. If you look at these personalities, I doubt seriously that they paid attention to any of these things that we're now propagating from exercise

to the healthy diet. There's also good evidence that many of the negative factors like traumatic stress by changing the microbiome has this long-term effect because a lot of these centenarians actually Holocaust survivors have gone through the most of your early life stress. Based on a simple model, you would say.

So what can we do? I mean, it's just coming back to your question. The interventions haven't really changed that much. You know, this is one thing when I wrote this anniversary edition and reread the book from 10 years ago, there hasn't really been that many novel, if any, practical recommendations that we can give based on the science. We know a lot more about the system now, but the most effective interventions are basically lifestyle and diet. You know, that's kind of a paradox. And I don't know if that will change.

If you ever will come to, I mean, it's kind of another topic. we can talk about that I mentioned in the Ennirisor edition. There's this new field in science of these bioengineered probiotics, which basically you can interfere with specific functions in the body. We don't really have those yet in hand for clinical use. Like custom probiotics for particular conditions. Yeah, for particular conditions. Like there would be one for obesity, one for inflammatory bowel disease.

is, you know, it's theoretically possible that that will happen. I've been involved in some of this research with, you know, both the estrogen recycling but also the inflammatory bowel disease applications. Yeah, we're not there yet, and we don't have any clinical trials that show that this actually works. Yeah, I mean, that's the challenge. You know what? I often say the absence of evidence is not the evidence of absence.

And I think, you know, the fact that we haven't really had funding, which is the problem for a systematic approach to treating gut issues is a problem. And it leads to kind of a gap in the scientific literature where you've got a whole group of physicians who are using the clues in the science because there's a lot of clues. There's a lot of things pointing to what works and what's helpful. There's prebiotics or probiotics or polyphenols or feeding CBO or fungal overgrowth or gut repair. I mean, there's a lot of sort of animal data. There's some human data, but it's not in a systematic randomized controlled trial. And that's really just an artifact of our really screwed up scientific paradigm, which is funded mostly by pharma and for things that you will make a lot of

money from. But restoring gut health and gut function is not to say something you're going to make a lot of money from. So it's been done by a group of physicians in functional medicine. We have a whole system that we've developed that's based on a framework called the five-hour program, essentially to reset the gut, which is remove the bad stuff. like whether it's allergens or bad bugs or sebo or parasites, replace what's missing. It could be digestive enzymes or hydropark acid, prebiotics, and then re-inoculate, which is probiotics.

And then, of course, repair, which is providing things to help the gut, soothe the gut, whether it's, you know, vitamin D or vitamin A or omega-3 fats or various kinds of things like glutamine that might be helpful. And then we help, we store the nervous system by helping with relaxation techniques and various kinds of nervous system reset. And it's, it's, you know, it's not been scientifically validated, but it's something that's been used clinically, like thousands and thousands and thousands of patients.

And it seems to work, even when we don't completely understand what's happening in the microbiome. I've experienced that quite a bit, you know, like where I've had, you know, like I've had recently had a patient with severe, sebo, bloating, distension, constipation, pain, neurocognitive symptoms, fatigue, brain fog. And I basically treated her with three antibiotics because she had sulfur gas, hydrant gas, methane gas. And then I treated her with herbs to help keep things calm down after her.

And I gave her basically some things to help her rebuild her microbiome with probiotics and so forth. And she's doing amazing. I think for those people suffering with issues, and by the way, you can have gut problems and have no gut issues. That's a big thing I want to talk to you about. But if you do, there's usually a way to get through it. And typical gastronology doesn't really focus on it. So I love your perspective on that and how you think about kind of bridging that gap. Yeah, I find that what you just said is really interesting. So if you had to talk to me 10 years ago or 15 years ago, I would have said,

I don't believe it. It has to be evidence-based. We have come to so many breakthroughs in medicine with the traditional model and the randomized controlled trials. And in the meantime, I've sort of changed the view. So, warnings, I feel, you know, there's a lot of affinity I feel with the functional medicine approach, you know, and I've got invited to meetings, which always says surprised me in the beginning because I've not talked that pleasantly about functional medicine. The second one is, you know, there's this whole historical evidence-based body of, of, of, of, of,

of evidence from these ancient healing traditions. So if people kept something like turmeric, for example, over several thousand years as a remedy and an anti-inflammatory compound, it can't be wrong. I mean, people wouldn't not be that stupid to take something that has absolutely no effect or no benefit. And there's many of these examples. So that historical evidence for me is also, you know,

one point that I sort of realize and also realizing the shortcomings of randomized controlled trials, you know, clearly having done many of these studies and having seen that, you know, I mean, the heterogeneity of people, that's kind of one of the big problems. You know, I mean, yeah, in, in bread mice,

you can do a randomized controlled trial. Yeah. 100% positive, you know. Right, right. But humans are not all inbred identically, genetically, and they all have different backgrounds and different genetics and different microbiomes and different lifestyles. And it's definitely a problem. And I think, you know, that's a fundamental flaw in the scientific model that we're using.

And we don't know how to create N of one study, which is basically what in the NIH out says is the highest level of evidence, which is, you know, if you have a single person, you can use them as their own control before and after treatment and measure the changes or outcomes. and that's a validated measure. And then since we call those anecdotes, but actually if they're systematically done, they actually tell you a lot of information. Yeah, it's kind of, I find that interesting for myself

that I would ever, you know, but being a, you know, hardcore scientist, I've always been open to, I have my own hypotheses, and if they're not confirmed by reality, then I abandon them. Move on to a better hypothesis, and that's sort of been happening with this,

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So maybe you can take a little time kind of going out of this reductionist model that we're talking about and kind of zoom out and go, okay, here's the microbiome. You've been studying it for a long time. and you've done a lot of research in this area. How would you sort of explain to people how the microbiome interacts in the body to create so many different health issues? And how do we start to think about with the mayor method actually,

or the mayor model, actually helping people to reset their gut? Yeah, so there's one simple story that, you know, I tell patients. You know, there's a lot of beneficial molecules, the microbes, generate metabolites from our diet and from whatever we ingest. And but there's, so there's a lot of compounds that cause inflammation or low-grade immune. So when I talk inflammation, I always prefer low-grade immune activation because you don't get the same inflammation as you get an inflammatory bowel disease. You know, it's not something that you necessarily see on an endoscope or aniofrey.

But at the same time, the micros produce these beneficial molecules. And so far, our view is limited in this, so these short-gen fatty acids, mainly butyrate, that have an anti-inflammatory effect and many other health benefits at the gut level and throughout the body and in the brain as well. So the balance between these harmful substances that get into our system and these anti-inflammatory molecules, I think ultimately it determines, you know, the health condition of your organ, you know, like my main interest has been on the brain. So you could, in theory, you could, you know, do some unhealthy things and have all these chemicals

in your diet. But if you eat a highly diverse diet that's highly diverse in fruits and vegetables, you will just, generate sufficient amounts of anti-inflammatory molecules that counterbalance these negative effects. So you'll never have just a pure positive influence on the brain from your diet. It will always be mixed. And I think it is that balance. So that's one thing. The second explanation is the microbiome sits at this interface between what we call the ex-posome,

the world around us, and our immune system, microns away from all these, immune cells, one mistake that's being made, you know, in this communication would trigger a lethal inflammatory reactions. It's amazing that that does not happen normally, so there's many protective mechanisms. But I think to see the microbiome as a master translator in our bodies, that translates whatever goes on around us, comes into the diet, and which comes to us through our mind, because that goes down to the microbes as well, the microbes translate this information into the body's own language. And if that translation has an end result of a pro-inflammatory, you know, neurodegenerative message, then that's what the disease comes in. So I wouldn't say

it's, it's as, you know, my cabam is another organ. I'd like to see it as a master translator, which is able to speak the same language as, you know, the molecules, these biological molecules that our brain uses and our nervous system uses, immune system uses, and the microbes. I mean, they're all similar, so they all speak the same language. But you need that translation, this translational step in between to tell the body how it should respond. So it's almost like the gut microbiome is a transducer from

the world to your body that then changes what happens across all your physiology. In other words, the what you eat, your lifestyle, toxins, infections, all that is affecting your gut microbiome, and that in turn is affecting every biological system in your body, regulating it, changing it, modifying it, and both from the short-chain fatty acids that get absorbed, but also the microbial metabolites. San Jose at Cleveland Clinic, I asked him once how many of the blood metabolites that are existing in the blood, and there's maybe 6,000, how many of those are from the microbiome?

He's like, I think a third or half. I don't know if that's true if there's any evidence to that, but is that true? That is true, and the problem is we don't know, for most of these, we don't really know, with the exceptions of TMAO, for example, that, you know, the Sanhazen example,

or certain triptophan metabolites like canoeran, for most of them we actually don't know, or we only know, in a reductionistic way. So people have used more these metabolites, put them on a cell culture and see what happens

or, you know, into mouse model. But that's not how these metabolites act. They're all interacting with each other. It's, again, the systems biology concept comes in. It's a whole network of these, what you may call, you know, potentially harmful metabolites and the beneficial metabolites

that constantly interact and compute the outcome. and the outcome in general in a healthy person is always positive, which is amazing. I mean, considering what we put into our bodies and are exposed to an environment, now with the microplastic, it's absolutely amazing to me the resilience of that system.

So the engineers of evolution, you know, have done a masterful job. That's true, that's true. But I think, you know, we're really hard on microbiomes in the 21st century. We have an increasing rates of C-section, lack of breastfeeding, early antibiotic use, increasing toxic load, increasing food sensitivities, I mean food additives that emulsifiers and other things that destroy the microbiome.

And then we end up with poor diets, low fiber, ultra-processed food, and the list goes on and stress. And all of this is affecting the microbiome directly. If I can comment on this, so the system is masterfully designed over millions of years, or billions of years, I would say, the last 100 years have created a mismatch of that system with, you know, of the microbes that have adapted, they're rapidly adapting to all these environmental changes

because with them millions of genes, you know, they're much better in doing this. But our bodies have not, like the immune system has not been able to catch up with this. Nothing has prepared our immune system for what we're experiencing today. And so there's now this mismatch between the microbial world that is adapted to what we put in and feed it and expose it to and our much more conservative human biology. So this response of inflammation is basically a response to the system doesn't recognize this dramatically changed microbiome world. You know, it's, even though it may not necessarily be harmful to us, but that there's now, the immune system rings the alarm bell because what it sees that these microbes now,

there's fewer them, there's more, you know, pathological molecules, fewer beneficial, protective molecules. And, yeah, I mean, I like this concept, the mismatch of, that has occurred in the last hundred years, that that's in some ways the main problem that we're facing. And how are we going to deal with this ultimately? I'm not exactly sure. You know, we can try all kinds of things we do right now, but unless we change the environmental situation,

which I doubt we will, you know, it's hard to say how we hundred years from now. What this looks like? Yeah, well, we have to take care of our microbiomes. And I think there's a whole, I mean, whole evolution of this research that's pointing to more specific personalized probiotics, prebiotic foods, the role of polyphenols, all the colorful plant compounds that help fertilize the gut, fermented foods as an intervention. And so there's a lot of things that you can do

to really take care of your microbiome. I think most of us don't think about, oh, how am I going to care for my microbiome? They go, I'm going to exercise for my muscles, and I'm going to make sure I sleep and I don't need too much sugar or whatever for my health. But people don't think, oh, there's this whole organ in there that I really need to pay attention to and I really need to take care of. So if people haven't thought of that, they need to.

And when they think of it, I'd love you to sort of walk through your model, the mayor model that you developed, of how to really take care of your microbiome in a microbiome unfriendly world. That's what we live in. So I think the first thing you have to realize that, you know, I've created these pillars

that all influence healthy longevity and health. And at the center of this flower is the brain gut microbiome system, this complex system, bi-directional communication, from the brain to the gut to the microbes and back, which I consider the main homeostatic organ in our system in our body. So the first thing is we have to realize that, the second one we have to realize that the influences, which are the petals of the flower,

that influence that end result of homostasis, the weight of these petals varies between different individuals. It's very personalized. So, I mean, the pedals or these influences are, you know, food is one of the most important ones, exercise, mindfulness, resilience, community, connectivity connections, purpose and sleep. So these seven influences, they all have variable influences in different individuals. So in some person, it may be diet plays 100%, causes 100% of the variance of the end result of homestasis and balance. If somebody else, diet may play 20%.

You know, they may be on a very unhealthy diet, may not exercise, but have a very strong sense of community and both socially and spiritually. And that compensates for this. So I think the main thing to realize is we're not all the same in terms of the importance of these influences. And so we have to design. Every person has to design. They have to look at themselves or the healthcare practitioner has to look at what pattern does this individual fit in. And then focus on building up the things that are the most important in. that person. So would I tell somebody, you know, his metabolic syndrome, is obese, doesn't

exercise, probably would want to work on all of these pedals, you know, slowly. And that's what I, you know, propose in this Maya model book, do it gradually. If there's no, you know, you don't have to do this, you can't do it within a week. You have to gradually work on all these challenges. and ultimately you will feel that you become in charge of your health and your overall resilience and balance and you will decrease the risk of developing chronic diseases. So, I mean, the first is buying into the model, this seven-pillar model.

Other people have proposed similar kinds of models as well. We have to get away from one thing that if you do, if you meditate five hours a day and do nothing else for your health, it's not going to help you. Monks don't live into their hundreds. You know, they usually, I've always looked at this when I was, you know, trekking in the Himalayas. Yeah, you don't see people that live into their hundreds. You know, that's not their goal anyway, you know. But now our goal is healthy longevity.

I mean, I think, you know, society has finally recognized. recognize that this is a, for the most important goal, healthy longevity without billions of pharmaceutical products keeping us alive. And for that, I think you need to have a whole program. I think that functional medicine also proposes that. You know, you don't say to somebody, you just have to take that one supplement and we'll take care of it. So I would say all of these things will be reflected in a change in the microbiome, which is interesting. So you would think why does sleep affect the microbiome or a sense of purpose or sense of community? But studies have shown that. It's reflected in a healthier microbiome characterized by generally increased diversity

and richness and increased number of anti-inflammatory producing organisms. Yeah, this is my main insight in the last 10 years, I think coming from the mind-gut connection to this holistic program where the microbiome still plays a central role, but it's sort of a readout, which is a good thing. So when we do stool tests, and I think we are getting better in interpreting these stool tests, I still think we're not there where we want to be ultimately, that we have a readout and with a predictive value. Are you at high risk for also? or when you do this in your 20s or 30s, but we will get there. I think that technology is advancing and also AI, how to interpret these, you know, massive amounts

of data you can get out of the microbiome. Yeah, I would say the microbiome is an excellent readout better than most of the other components, organs in our body. I mean, I think it's quite an interesting model you're talking about because you're saying basically you are understanding now that outside and people, you're saying, you are understanding now that outside influences our thoughts, our feelings, experiences. All these things affect the microbiome. Exercise, stress, sleep.

It's bidirectional, though, because also the microbiome affects all those things. So it's kind of this conversation that's going on all the time between the microbiome and the brain. And, you know, I think, you know, I remember when we were trained in medical school, you're a little bit older than I am, I think. But, you know, we learned that irritable bowel was a functional bowel disease. And it was, we joked and it was super tentory. meaning it was all in your head. And that we identified that people were anxious,

and that was why they had this problem. And we kind of blamed them in a way, because it's your fault, you're just anxious. That's why you have these digestive symptoms. But I remember a paper, I think it was in JAMA many years ago where they, I forget the scientists, but we was talking about the other direction, that the enteric nervous system and the leaky god

and the dysbiosis and the inflammation the gut was sending signals back up to the brain when there's a dysregulated microbiome to cause brain dysfunction, whether it's mood issues, behavior issues, attention issues, you know, autism spectrum issues, all that is affected. And so I think, you know, your model is really important because it's sort of both top down and bottom up. And it's, you know, it's sort of, I mean, I would say I hate to use that expression trendy,

but if you look at science, I mean, it's more and more moving into this direction of, you know, systems biology. And we also do it in our own research. I mean, analyzing these complex data sets with data from brain imaging and behavioral and blood values and, you know, the microbiome values and diet, you put all this into a pot. And then you have sophisticated AI techniques work with this data, which you cannot as a human brain comprehend in a similar way. So this, I think, is happening in many areas. this overabundance of data that we can generate and gather. But we haven't really been able to do the best way in interpreting it

and making, creating action items based on individual patterns. So there could be pattern one in one patient and pattern two in another patient. And there's always attempts to do this in a simplistic way. Like many of my colleagues, we strongly believe that I will make the breakthrough in this. Let's talk about that because I think what you're speaking is saying really important because there's, you know, there's probably 40 trillion cells of bacteria in your gut. There's probably 102 of more times as much DNA from bacteria in your gut as your own DNA. It's constantly making proteins and metabolites. There's thousands of metabolites in your blood from the microbiome. It's almost incomprehensible. Like the average doctor can look at a panel on blood test. It's, you know, 20, 30, 50, 100 maybe. But when you're talking about thousands, it's just hard to process all that. And so you're talking about an era that were where AI is going to help us understand the complexity of human biology. And I would really love to hear you kind of talk a little bit more about how this is going to affect our thinking about the microbiome

and how it's going to affect the clinical practice of medicine around chronic illness and how chronic illness and the microbiome are so connected. I think it will dramatically change the way we look at the microbiome. I still, even though, you know, the stool tests have gotten a lot better and some of these, some companies use AI to interpret them, or put them into context of published data. But I think ultimately, we will come up with conclusions that are way beyond what we're talking about now.

You know, it's, you know, this whole still, I mean, the current approach that look at these microbiome tests and look at which ones are outliers from a normal pattern, and then you focus on these three or four organisms and you create a probiotic or a prebiotic cocktail that will strengthen those. I personally think that that will kind of disappear, really. I think we will have footprints.

I will get footprints of people, and then we compare this with tens of thousands of people, and we see that these footprints are recurring in different populations. and we can connect them to, you know, dietary lifestyle patterns. I mean, this is, I think it's going to happen in the next five years. You know, we're sort of confronted with ourselves. We have these massive data sets and, you know, collecting the data is one thing,

but then really grinding them through this analytical meal is still an unresolved issue. So that's definitely going to happen. I think guidelines will follow from that. I mean, the current guidelines, you know, they often focus just on diet. If you look at what happened in IBD, first, there was a recommendation of a fiber-poor diet being beneficial patient with Crohn's disease. Now, you know, we have pretty good evidence that a Mediterranean-style diet is the best, you know, anti-inflammatory intervention you can do. if you don't have strenosis and stenosis. So I think we will get much more rational recommendations.

And also what I see, you know, like at UCLA, if somebody comes complex patient with IBS, they're not just going to get a dietary recommendation or a probiotic recommendation. They also get a behavioral assessment. and then if, like many people that make it to a university clinic, you know, they have the strong brain component being early life trauma, anxiety disorder, depression. It depends on the population, but in the most severe patient populations in ABS,

you can't deal with the issue just with a dietary change or with an antibiotic. You know, you have to embed this in a holistic approach, and you need the, you know, you need the experienced practitioners in these areas, gut-focused psychologists, you know, got CBT, gut hypnosis, kind of specialized people. So I think it's already changing the system when I look at what happened at UCLA since, you know, when I started there, we first started a clinic like this, so a holistic clinic, but it took a long time, it took like almost 40 years before. This is now becoming an official program of our GI division. And it's happening in other universities as well, in other settings as well. So I think

we're moving for some, and I shouldn't just say it's important for IBS. Same situation in inflammatory bowel diseases, you know, where we get quite a few people that do not respond satisfactorily to biologics, were increased in the dose of the medication is not going to do it, but you have to identify mechanisms in which the brain basically drives the inflammatory condition in the gut, in addition to what goes on in the gut. It's quite an exciting time for the microbiome,

I would say, I think we're learning so much. I want to kind of dive into another, part of the conversation, which is about longevity and aging and what happens to our microbiome as we get older. And there seems to be some interesting literature around, and you've discussed this around the microbiome in Parkinson's and Alzheimer's. And the question is, how do we think about the aging microbiome? You know, is in hallmarks of aging now, which is that are the features of aging, it seems be one of the things that goes add. And it seems like it's a modifiable risk factor. You know, we've looked at really exceptionally healthy, older adults, and centionarians, and their microbiomes,

I wonder if they're different. So maybe you can talk about some of the aspects of longevity and the aging microbiome and how we need to think about that. Yeah, so the initial studies were done, you know, on selected populations, like in homes for older people. And, you know, there was a confusion of how much the change in the microbiome that decreased in diversity and richness was actually a consequence of this dramatically changed lifestyle in these retirement homes or nursing homes, both in terms of diet, particularly in terms of diet, but also in terms of, you know, loss of purpose and, you know, loss of social interactions. But we know in the meantime, that's one factor, and many aging microbiome studies have been

affected by this, that they have not been controlled for factors other than age. So we know that, you know, I mean, a microbiome diversity is fairly well maintained through age from midlife to age. There are changes. If you compare microbiomes from different people, they become more different. So some more individualized pattern evolves. There is a decrease in certain microbes that play a role, for example, in bile acid, metabolism, and the gut. So I think we've slowly getting a fairly good picture in somebody that is a healthy centenarian. It's not the simple explanation that we gave like 10 years ago.

It's just a decrease in diversity and that's why they're more prone to develop diseases. It's really, it's a much more nuanced. What's happening then? I think there's dramatic changes in these factors that we talked about earlier, these these pedals that influence the microbiome, the exercise obviously goes down pretty dramatically in the majority of people, food unless you can afford to have your 30 different plants of vegetables a week delivered to you, you know, will decrease in a variety. So this decrease in diversity and this decrease prevalence of the beneficial microbes

is definitely a risk factor for the manifestation of many of these. diseases that come with older age. But we have to realize these diseases like Alzheimer's and Parkinson's, they start at the microbiome level in our 40s. You know, there's more and more studies that showing that you can actually predict changes based on, you know, microbiome, you know, negative changes early, much early life. So, but then when the microbiome goes down and its main functions, the disease, the disease, disease actually then becomes apparent. You know, you could probably, it's sort of a good way of

identifying what we can intervene. So we can intervene at midlife in patients at high risk that have absolutely no symptoms, but we can see some signs on the microbiome level that indicate, don't guarantee, but indicate that this person is at high risk. But we can certainly, once the first signs and symptoms of the neurological disease, and I've talked to. particularly about Parkinson's and Alzheimer's, to really aggressively reverse the changes that are going on within the gut microbiome. I would say at that age, probably diet,

well, is more successful and more practical than some of the other changes, but also just connectivity, purpose. I mean, all these things, I think that so many elderly people, you know, we had this epidemic of loneliness, which is definitely it's reflected at the gut microbiome level as well. That's kind of the intriguing thing. It's like, do you have this mirror inside of you?

The better we get in identifying the subtle changes that reflect environmental influences, the better will be in preventing them and treating them aggressively. If you had a full-blown disease, I don't think you need to do it, a microbiome test. You know, it's not going to change somebody who has full-blown Parkinson's disease with all the neurological symptoms. It's not going to make a difference. Same with Alzheimer's.

In Alzheimer's disease, it's almost like the opposite. You know, you want, there's evidence that a keto diet is actually beneficial because it is anti-inflammatory effects on the brain in somebody with, you know. Yeah, yeah, I've seen that. I've treated patients with Alzheimer's and they use keto dies, and it has been remarkable to see the way it impacts them. And I think the question I would have for you is now sort of we think about taking care of a microbiome and the aging microbiome is a thing in terms of contributing to acceleration of aging through increasing more of a sterile inflammation in the body and affecting every other system. Let's kind of walk through practical steps, because you mentioned the 30 plants. I think that's important. I want to talk about the specifics with you of what

what you actually recommend to people so that they can keep their microbeams healthy as they age. Yeah, it's actually not too different from what I would recommend, you know, to all my patients. And, I mean, it's kind of, sometimes it's kind of embarrassing to say that, you know, so with all this fancy science that we have and all these subtypes and personalize and diet, that the approach is fairly standard, you know, the overall approach. It has to be, so the standard concert, like the 30, 35 plants and vegetables, has to be adapted to the taste preferences, because food has to be enjoyable.

A major function of food on our health is the enjoyment and the pleasure. It's closely linked to the centers within the brain. So I would say, you know, start with a breakfast bowl that has, many the ingredients seeds and oats and chia seeds, fruits, fermented fruits in it, so you can easily come up with five to ten ingredients that you had a spoonful to that morning bowl that you have rather than just have your yogurt with blueberries.

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And the reason is that the science is there that it damages your microbiome. So if you, you know, 60% of our diet is ultra-processed food. That is directly damaging our microbiome. It's increasing what we call leaky gut because of some of the emulsifiers and other additives. So, you know, it's not in artificial sweeteners, affect the microbiome. So people think, oh, it doesn't matter, but like it's such a big deal that I think if when people can do one thing is swap out algebraos, food for real food and eat a lot of plants, right? Yeah, and then, I mean, just to make it practical, you can create salads, not the typical lettuce,

salads and now, you know, get a bad wrap because of this, this infectious diseases. So we've experimented this at home. You can easily add 10 different vegetables to a salad, to a complex salad. So if you start your morning like this and end your day with a salad like this, you actually already fulfill this criteria. And you avoid the ultra-processed fruits, particularly sugary stuff. I mean, we still don't know exactly with the ultra-processed foods. I mean, there is this controversy about this context.

that it's too loose and not, and some people say it's all the sugar, but that's definitely not, not all of it because of, like all the chemicals, they don't even know what they are, they're printed on the label. It's kind of amazing. Like on an airline, you look at this thing with the so-called pretzels. The pretzels are the minor part of this. And if it's a I'm in a package, unless it's got simple ingredients that you recognize. It's definitely not good for you. Do you focus a lot on prebotic foods for people? Because I think, you know, I think there's more and more data on prebiotics and polyphenols rather than probiotics as a benefit because that really changes over time the composition of your microbiome, whereas probiotics is sort of just gives you something

additional, but it doesn't really sort of shape the bunk that are growing in there. Yeah, and coming back to this, I mean, these 30, you know, fruits and vegetables. So from most vegetables and, I mean, also for some of the fruits, fiber is obviously a very important component, the health-promoting component, because microbes are masters, I mean, they love the fiber because they break it down to their own food, main food source, but they also converted into like these short-chain fatty acids again. From a lot of the fruits, you get the polyphenols, and that's a group that sort of been, you know, I've been. I would say mislabeled or misrepresented in terms of calling them antioxidants, because

it's a very interesting part of our diet, just like fiber. It's not absorbed in our small intestine. The molecules are too big, so it has to be broken down. The same, but the polyphenols are broken down by the gut microbiome into smaller molecules, which are then both, again, food for the microbes and are absorbed as health-promoting phenols and phenolic compounds that circulate in the gut. the body. And there's some very good studies.

People always forget that. You know, with some polyphenols, like flavonols, for example, the studies reach all the way from molecular studies showing that they, you know, faster vasodilation of small blood vessels, both in the heart and in the brain, increase nitric oxygen production with the vasodilator. And so we know the mechanism how they actually protect these organs, both the brain and the health. And we have clinical outcome data from pretty well-designed clinical trials.

This is an exception. So I think this is often, it's often swept under the carpet that people say, yeah, the antioxidants, yeah, it's good to have antioxidants. It's something much bigger than that. Yeah, they're kind of what I call them biological response modifiers. They basically are signals or chemical signals that regulate all sorts of systems in your body. And I think we co-evolve with all these plants to do all these things for us, particularly a microbiome. And we have to feed ourselves, but we also have to feed the microbiome.

And I think the focus on more prebiotic foods, more fermented foods, more polyphenols. these are things that are different than just like taking a probiotic that I think people really could learn about. And I think you could probably cover this in your book, right? The mayor model and talk about these various aspects of how to optimize your diet for your microbiome. Yeah, and I always emphasize this point. You know, it's actually quite easy to find the right diet.

If you identify a diet that's beneficial for your microbes, for the diversity and the health and the richness of your microbes, that's the best diet for you as well, because we have lived with these organisms for millions of years, our ancestors, you know, pre-human ancestors done that as well. So I always say the general advice is eat what's best for your microbes. And the two main categories that pop up are definitely fiber prebiotics and polyphenols. I mean, there's obviously many of these other vitamins and micronutrients that you can add.

didn't, but the main workforce are really these three groups of ingredients. So there's the fiber, the polyphenols, and the prebiotics, I'm not clear, the third thing. It was prebiotics and polyphenols, and then the third part. Yeah, I mean, so the third thing that I recommend for the diet is, you know, naturally fermented fruits. And the reason I'm saying this is because, you know, people always talk about, you know, I mean, when the people started in yogurt? But there's thousands of years' history of our ancestors

fermenting food products in order to preserve them, not for their own health. So our immune system and our, you know, God had enough time to adapt genetically to these fermented foods. Again, the larger variety of these fermented food components is, the better we think. I mean, the variety is always sort of a key component in the recommendations. It's not just what do you eat. It's what variety you eat and how often do you eat it. Yeah, and I think, you know, you're simply more specific. There's a lot of specific foods that you can eat that are helpful.

And I, you know, I try to cook these and eat them regularly. One is like garlic, onions, shallots, leeks, they're great probiotic foods, asparagus, dandelion greens, beans, lentils, chickbees, oats, barley, cooked potatoes. they're cooled, rice or pasta that's cooled, makes it more resistant starch, green bananas. There's a whole bunch of these that are really great. I think there's also polyphenols. Like I know, for example, cranberry, pomegranate, green tea, and a lot of the colorful compounds really help a lot. And those I've used myself personally to help my own microbiome, and I see a change from it. Have you had a microbiome?

I'm sure you had multiple stool microbiome tests done. Yeah, yeah. Oh, yeah. I've had them, and they definitely change and they shift in response to what I'm eating and my overall health. So I think, you know, the bottom line is it's hard to change your microbiome through probiotics, but if you use the fermented foods, the prebiotics and the polyphenols, you're naturally going to be growing a better garden, essentially inside your gut.

And I think it's a really empowering thing to sort of start to think about when you're eating, actually use the science around what your microbiome likes to eat. to feed them as well as yourself. And it's not, you know, it's, it's not rocket science. It's actually fairly straight. Once you accept that concept, it's not rocket science. It's, and it's, it needs to be pleasurable. Like, I mean, I always emphasize this, you know, if you go to Mediterranean countries,

I mean, they love their food. They don't eat it because it's healthy, you know. Yeah, yeah, they eat it because it's good. It tastes good, right? That's right. And if you eat this way, you can, make delicious food. I just, I think about just, you know, being more deliberate. And also just being aware of all the things that harm your microbiome. And I think it's important to be aware that,

you know, eating at all your processed food, you know, a lot of different pen medications, exposures to environmental toxins, all these things will affect your microbiome, stress, your relationships, your connections, the amount of exercise, all the things you talk about in the mayor model are all things that modify the microbiome in one way or the other. and the levers are there. I think, you know, I'd just like to close by asking you, you know, this is sort of a general conversation about creating a healthy microbiome.

But, you know, I find it as a target and very specific target in order to treat a lot of conditions that are medical conditions, using the microbiome as a direct kind of doorway to many, many health conditions, whether it's autoimmunity or allergy or asthma or pharyngia or even things like migraines or,

You talk about the strobolome, which is, you know, basically the estrogen metabolism and the microbiome. We didn't get into that too much, but that affects women's hormones. So treating the gut can often be a doorway to many, many different problems across many, many different specialties. And I wonder sort of how you think about that and where the sort of evidence is on that right now. It is amazing. I'm still amazed about that, you know, and as a sort of a, you know, physician and scientist, it's kind of, you know, it's kind of, of against my nature to say there's this string theory of health and diet that explains everything. But I think the microbiome has that quality that you could use it as a, and I keep emphasizing

its connections to the brain and the gut. I mean, the gut is an amazing organ, you know, has all these components in it, an immune component, a hormone, component, the nervous system component, and the microbes know exactly how to communicate with these systems within our gut. So I would say it doesn't surprise me. Once you understand that, that it has so many influences on particularly the immune system, when you think about almost all the immune cells travel through the gut and reach the distant distant destinations like what happened during COVID.

You know, COVID doesn't start in the gut, but the immune cells that are in your lungs have a connection to their past when they, you know, did their migration through the gut-based immune system. And so even in the same with the brain. So many cells that end up in the brain have a history of encounter. with the microbiome. I think, you know, we have to be careful not to come up with simplistic conclusions, you know, now we know everything, you know, but I think we have to acknowledge that we have discovered

unexpectedly a system in our bodies that is doing, it's almost like rivaling the brain, you know, in terms of its complexity and its influences on. It is. I mean, I think we're kind of in the, you know, it's a new sort of era in medicine, I think, where I think the microbiome has kind of shaken some of the foundational principles of traditional medicine, which is specialty in organ focused and sort of understands how now the gut is related to every system in the body,

and the body's a network, and the microbiome is part of the network. And we really have to think more about network and systems approach, to treating disease rather than this reductionist model. And I think, you know, what I've found over the years, being a doctor, seeing patients, is that when I focus on gut health with people across the spectrum of diseases, whether it's some with Parkinson's or allergies or migraines or PMS or, you name it, autoimmune disease, that people will get better, that people really do improve. And, you know, I see it over and over in a way that's pretty striking.

And I think, you know, the methods are still being worked out and we're still at the beginning of this era. But it doesn't mean that we can't apply these principles clinically, practically, because they're very low risk. Generally, they're very, they're very effective often. And, you know, there's not a lot of downside to eating healthier and managing some of those things, taking some prebiotics and probiotics. It's kind of low risk and the yield is quite high. So I think it's kind of an exciting moment. So how do you see this field going over the next 10 years? And just to wrap up.

I think there's going to be bigger breakthroughs in terms of practical applications than have happened during the last 10 years. I think this is, the science is still accelerating. I think the acceptance by practitioners, I mean, you see the increased popularity of functional medicine. Even for traditionally trained physicians, it keeps increasing for that very reason. And so I think there's going to be, I mean, there's very strong headwinds ahead. You know, we're going to be facing, I mean, in the next 10 years it's hard to imagine actually what this world is going to look like from all these multi-crisis we're experiencing, which also will affect food production and, you know, environmental exposure, heat and all kinds of things. but I think there will be I think there will be a new era of holistic

you know I had to use this old-fashioned term but holistic medicine medical practice that takes into account now all these insights that we get from digesting and integrating all these different pieces of information I think people hopefully you know we see some

efforts that with the maha movement. I mean, that's something that you couldn't expect 10 years ago. You know, something like this would happen. Sorry, which movement is that? The M-A-H-A. Oh, M-A. M-H-A.

Oh, Maha. Yeah, yeah. Make America help you again. Okay. In my opinion, this doesn't go far enough. You know, there's still a lot of loopholes in it that will not do it. But it's definitely something, something like this could happen imagine what will happen

the next 10 years, you know. Yeah, that's true. It's an exciting moment with the convergence of systems medicine, with AI, with changes in health policy, people awakening up to the fact that we're in a different era. I think it's quite exciting. And I think your work is such a key part of it, and you really contribute so much to the field. I definitely encourage everybody listening to get your first book, which is an updated edition, The Mind, Gut Connection, and also the new book, which is the mayor model, available to where you can get your books. And the mayor model is really about practical application is a beautiful book. It's well designed and it's easy to use. And I think that it covers

seven pillars really helping your microbiome, food, exercise, mindfulness, resilience, community purpose, sleep and talks about how you can, you know, focus on the right diet, very specifics, things we talked about even more detail. And I think it'll help everybody listening to develop a healthier microbiome, which is really the key to good help. And I think many ancient healing systems have figured this out a long time ago, but we're finally figuring that up. out in the West. So thank you so much for your work and your contribution and your new book. And I can't wait to see what's going to happen in the next 10 years. Thanks for having been usual. Greatly appreciated it. Mark.

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