The Liz Moody Podcast - Ask The Doctor: Gut Health Edition—Eliminating Bloat & Constipation, The Best Supplements, Nourishing Your Microbiome and MUCH More with Will Bulsiewicz, MD

Episode Date: May 13, 2020

This is the third edition of Ask the Doctor, where I ask functional medicine doctors a ton of questions in a single episode so you can reap the benefits of all of their knowledge (check out the first episode, featuring Dr. Will Cole talking about inflammation, hormone balance, birth control, and more, here, and the second episode, which features Dr. Ellen Vora in the most comprehensive conversation about anxiety ever, here). This episode is all about gut health, and features the amazing Will Bulsiewicz, MD, known as Dr. B, the Gut Health MD. Dr. B is a board-certified gastroenterologist, a graduate of Georgetown University School of Medicine and was chief medical resident at Northwestern Memorial Hospital and chief gastroenterology fellow at the University of North Carolina Hospitals. He’s authored more than twenty articles in the top American gastroenterology journals, and he just released his very first book, Fiber Fueled.  This episode is SO comprehensive—I tried to ask Will basically every question about keeping your gut health, including: How alcohol consumption impacts the gut microbiome The best type of alcohol for gut health The cause of acid reflux and how to deal with it The best supplements for gut health (and the ones that aren’t worth your money) The number one thing you can do to help nurture a healthy microbiome The sneaky common beverage that causes a LOT of bloating The best type of diet for gut health Is collagen good for your gut? Is coffee good for your gut? Are food sensitivity tests worth the money? Does apple cider vinegar actually do anything for gut health? The best type of tea for gut health The types of herbs for gut health Is cooked food or raw food better for gut health? The one gut health mistake everyone makes Exactly hat to do when you know you’re going to eat a bad-for-you-meal The connection between gut health and hangovers What everyone gets wrong about FODMAPs And so much more! You can find out more about Dr. B at theplantfedgut.com. We’d both of course love to hear your thoughts and reactions to this episode, so please tag him (@theguthealthmd) and me (@lizmoody) so we can continue the conversation over there. We’ll also be doing a follow up on Instagram Live next week, so write down any of your follow up questions and stay tuned! Enjoy! PS: Healthier Together is officially a number one best-seller! You can get your copy on Amazon or at lizmoody.com/cookbook. Please keep sending me your creations on Instagram—they make me so happy! PPS: My Actually Delicious 10-Day Detox is on sale for 50% off for a limited time. It has 10 days of plant-based recipes to nourish your gut, skin, and general health. Find out more at lizmoody.com/ebooks. This episode is brought to you by Garden of Life, one of my all time favorite gut health brands. I take their magnesium chelate nightly to help avoid constipation and help alleviate anxiety, and I love their prebiotic powder, which we talk about a ton in this episode. I also take their Mood+ probiotic and it’s made a huge difference in the health of my gut and my anxiety. This episode is also sponsored by GoMacro. For all of May, GoMacro is going above and beyond and donating 10% of their net-proceeds from their Peanut Butter MacroBar to Farm Sanctuary. As one of the nation’s largest animal sanctuaries, Farm Sanctuary has rescued thousands of animals and has cared for them at its sanctuaries in New York and California. You can get a whopping 30% off your order PLUS free shipping by using the code “healthiertogether30” at GoMacro.com. I highly recommend you try the peanut butter, the double chocolate peanut butter chip, and the oatmeal chocolate chip cookie! Healthier Together cover art by Zack. Healthier Together music by Alex Ruimy. Learn more about your ad choices. Visit megaphone.fm/adchoices

Hello, friends, and welcome back to the Healthier Together podcast. I am your host, Liz Moody, and I am a writer and cookbook author living in Brooklyn, New York, and I am so excited about today's episode, which is my third edition of Ask the Doctor. If you are new here, a bit of background. Because I've been a journalist for years, I have been lucky enough to have access to all of these amazing functional doctors as resources for my stories and as podcast guests. And these are people that are at the cutting edge of science. They marry Western and Natural Medicine in your own.

genius ways and it is not exaggerating to say that they have fully changed my life. But I also know that they can be hard to come by in many seasons towns and they can be really expensive to book private appointments with. So, once every few months, I have my very favorite doctors, the best of the best on the podcast and I ask them tons of questions that I pack as much info as possible into the episode so that you can reap all of the benefits of their immense wisdom. The first episode covers more general health questions with Dr. Will Cole. It's like inflammation and gut health and supplements and testing and birth control and things like that.

And then the second was all about anxiety. It is literally the most comprehensive anxiety episode ever with the famed holistic psychiatrist Ellen Vora. I have personally struggled with anxiety for years. So I made sure to ask her all of my hard questions. So definitely go and check out both of those episodes if you like this format. And then this episode is all about gut health. Today's doctor is Dr. Will B, the gut health MD. He's a board-certified gastroenterologist, a graduate of Georgetown University School of Medicine,

and he was the chief medical resident at Northwestern Memorial Hospital and the chief gastroenterology fellow at the University of North Carolina hospitals. He's authored more than 20 articles in the top American gastroenterology journals, and he just released his very first book called Fiber-Fueled. Basically, he knows his shit, literally. Sorry, I had to. I know that's such a dad joke, but it was right there, and I just had to make it. So please forgive me.

There is so much to go over when it comes to gut health, and it's honestly hard to fit it all into a single episode, but I did try my hardest here. So we talk about how to know if your gut is healthy, the best tests for gut health, bloating, what causes it, how to treat it, how to prevent it, how to treat and constipation, FODMAPs, the best supplements for gut health, the ones that aren't worth your time or money, the connection between acne and skin health and gut health, and the best time of day to eat your meals for gut health, the impact of intermittent fasting on gut health, and whether Dr. B recommends that.

He also talks about his thoughts on things like guar gum and xantham gum, and if those are bad for the gut, and that really surprised me. His answer, like, blew my mind for that a little bit. He talks about, like, one super low-hanging fruit, the easiest thing that people should be doing for their gut every day, lectins, the gut hot button issue that everybody likes to talk about lectins, alcohol, how that impacts your gut, acid reflux, your microbiome, how you can nurture a healthy microbiome, basically everything. I asked him also, like, if you go on vacation or if you know that you're going to have a bad gut day or week, what you can do to not feel bad or to mitigate that damage.

So if you're like me and you're not going to be perfect with all of your gut health stuff all of the time, you will like that part of the episode as well. I also like to do a lightning round in these Ask the Doctor episodes where I just do a bunch of things really quickly and I'm like, is this a gut yes or a gut no? So I talked about things like collagen, coffee, food sensitivity test, bone broth, apple cider vinegar, tons more in there. And it's just he quickly weighs in on whether it's worth your time, worth your money. And then because we simply did not have time to get to absolutely everything in this jam-packed two-hour episode,

we're going to do an Instagram live to go through all of your follow-up questions. So write down as many notes as you'd like when you're listening. And then follow me on Instagram. I'm at Liz Moody. And I'll ask for your questions. I'll do like one of those little question box soon. And then we will go live. I would say in the next week or two.

So definitely look out for that. And then this, okay, are you ready? I'm very, very, very excited about this. Dr. B and I have teamed up to do an amazing, amazing giveaway for this episode. We're giving away a private virtual session with him, which is worth $1,200 so that you can ask him all of your questions yourself. That I'm like jealous of that. Honestly, I would like that myself.

You can ask him stuff here too. It feels too personal for the Instagram live. I asked him all of the questions in this episode that I thought you would be interested in that would be widely applicable. But I would love to be like, Dr. B, this is how I feel at 8 in the morning. Or this is what happens when I eat this food. So you can pepper him with all of your individual questions if you win this giveaway. You can get all of the details about that on my Instagram feed at Liz Moody. So definitely, definitely go check that out.

It's one of the best giveaways that I have ever had the pleasure of doing. Also, as a final note, a lot of this episode is about how amazing a wide variety of plants are for your gut. So I would be remiss not to note that my actually delicious detox is on sale right now for 50% off. It is the biggest sale that I have ever done because I know that these are hard times. I know that a lot of us are thinking about money more than usual and I just really, really didn't want anybody to have to miss out because of price. It's a 10-day detox. It is all vegetarian and it's all about packing your diet with as many vegetables as possible, but in a way that's actually craveworthy and delicious, hence the name actually delicious detox. It's also laid out in a way that makes the cooking really easy so

you're not spending all of your time in the kitchen because nobody wants that. And I promise that you will never go hungry because I don't like feeling denied. I don't like feeling hungry. I don't like feeling jealous of somebody else's food while I'm sitting there like sadly munching a wilty salad. So I'm definitely not going to make you feel that way. Anyway, you can get all of the details at Liz Moody.com slash e-books. I've gotten so many testimonials from people who it's completely changed their gut health, their anxiety, their skin, their energy levels, and I cannot wait to hear how it helps you. Again, that is lizmoody.com slash e-books, E-B-O-O-K-S. All right, I cannot wait to hear your guys' thoughts on this episode, so definitely screenshot as you're listening.

and tag me with your thoughts, feelings, reactions, and enjoy this Ask the Doctor Gut Health Edition with Dr. B. Hi, Dr. B, and thank you so much for joining me on the podcast. Ms. Moody, it is a great pleasure to be here. I've, you know, I have been looking forward to the opportunity. Honestly, I'm kind of sad that we're not hanging out in New York together. I know, I am too. We both prefer in person podcasts.

And when you said that in your email, I was like, yes. And then I was like, no, because life had other plans, but this will still be great. Can you start off just for anybody who's not familiar with you, telling us a little bit about you, make us impress so that we take everything you say after now really seriously? All right. Well, what I'm about to tell you is going to confirm the fact that I'm a big time nerd. So I'm far nerdier than most people realize. So my name is Will.

I am a gastrologist, by the way, in case you're curious, the way that you say my last name is Bullsolitz. But if you were to go to Poland, it's a Polish last name, it kind of rolls off the tongue a little better in Poland. They say Bolshevitz. Oh, I like that. Yeah, it just kind of rolls off the tongue. And so I'm a gastrologist. I am a board certified gastrologist.

I'm also board certified in internal medicine. I practice in Charleston, South Carolina. I have a traditional medical practice. I'm very proud of the fact that I take care of all types of people from all different backgrounds and all different types of financial situations. I actually am really proud of that. And I guess, you know, my background is that I am traditionally trained from institutions that if you're from the United States, you've heard of these places. I went to Georgetown for med school.

I was at Northwestern for my internal medicine residency. I was a chief resident there. And then I went to the University of North Carolina. And, you know, along this path, I became very interested in clinical research and, started publishing papers, had these amazing mentors, some of the most famous GI doctors in the country, and really thought that I was going to be a clinical researcher and thought of myself as a cancer epidemiologist at one point in my life. So I did a, I honestly don't know what I was thinking, but I mean, I don't even know what I'm thinking with this book either.

Just being honest. Or in life in general. I'm flying about to see my pants, people. including in the moment, real literally right now. But I did a master's degree at night during my residency, so I would work 80 hours a week, and then I would do night school. And I did that for two years to get a master's of clinical investigation.

And then at the University of North Carolina, I was on a grant from the NIH and working at the School of Public Health, which is why it's essentially accepted among academics as one of the top three schools of public health, along with Harvard and Hopkins. So, and I came out in 2014, and I am this, you know, well-trained GI doctor. And patients start asking me basic simple questions like, hey, doc, what should I eat for my

IBS? Or if I have Crohn's disease, what diet would you recommend? And the problem is I didn't have great answers. I hadn't been trained that way. And there was this second problem that existed for me, which is, I guess, if it's okay with you, let me zoom out for a moment and talk about, you know, will the guy? Because yeah, I'm a doctor. But you know what? I, like any other human being, am prone to the same traps, the same problems, the same mistakes. And I grew up on the standard American diet in upstate New York.

I have two brothers. We would play basketball after school every day and grow hot dogs. That was like literally every single day, hot dogs. And when I was around 30, I noticed that, you noticed that, things were changing for me. I had put on about 50 pounds, lots of anxiety, high blood pressure, low energy levels, and low self-esteem. And it's kind of weird to talk about because, you know, this is a period of time in my life where to an outsider, they would look at what was happening for me professionally and they would go, but dude, you were crushing it. Like you were smashing it. What are you talking about? And I would say, I felt horrible. I felt miserable. I felt like I was 60 years old. And I didn't understand at that time that the

diet that I was raised on, you know, to me it was like, look, this is the way that I was raised to eat. This is the way that my family ate. How can this be the problem? I've always eaten this way. And I needed a wake-up call to figure out that this was the problem. And the issue is that my medical training hadn't really taught me how to fix this. And I needed a way out. I couldn't find out, I couldn't figure it out. And so I tried outworking it in the gym. And like, I mean, I'm not exaggerating more than an hour worth of workouts, including both cardio and weights on, you know, basically six days a week. I couldn't lose the weight. I just couldn't do it. And so what changed for me is like a benevolent angel came, the sky parted and into my life came this woman

who she's my wife, so I'm allowed to talk about her that way now. And she came into my life and we were starting a date and she ate differently than me. And she, you know, we'd go out to dinner and she would turn to the waiter and say, I know that this is not on the menu. But could you have them put together a plate and just like take the sides of plants, like the plant-based sides, put it on a plate for me and make it look nice? And I was like, what the heck is going on? here. I've never been around someone like this before. So anyway, I, you know, is I, I, um, I didn't want her to know that I was doing this because we were just starting to date and, you know, you want to kind of act like you're cool and you don't care. But I decided one day

to go home and instead of getting hearties, they had the $5 deal, which was a great deal. You get a chili cheese dog and a double cheeseburger. Rather than getting this splendid $5 deal, I decided to go home and make myself a massive smoothie. And actually, I felt like a noticeable difference immediately. I didn't have the post-meal hangover and was energized. And I went to the gym an hour later and I smashed a great workout. And that led me down a path. It did not happen overnight.

Happened over years. But it led me down a path towards a more plant-centered diet where I lost the 50 pounds. They disappeared on their own. I lost the anxiety issue, dropped my blood pressure, got my energy levels back, feel younger now. Like, I'm, you know, 40. And I feel younger now than I did when I was 30. And people ask me all the time, like, are you old enough to be a doctor? I'm like, I'm 40 and I drive a freaking minivan.

Okay. I got kids at home. So yes, I'm old enough to be a doctor. But anyway. Well, and more importantly, you married the woman. And I got the girl. And you got the girl. It's a full success story.

Yeah. That's the American dream right there. So the bottom line is that, you know, and the reason why I bring this up and divert away from just talking about like strictly, you know, the science, which I mean, I'll be honest, I'm a man of science. I'll admit it. The science has to be there. And if it's not, I'm not buying it. But what happened for me to open my eyes and go beyond traditional. Western medicine and my training is that I'm the guy who had the problem.

And I had to find the solution and the solution wasn't what I was trained. And so when I did find that solution, I brought it into my clinic for my patients. And I've had amazing, amazing results. And that's what led me to this place where now here I am. And it's like, man, two years ago, I had like 3,000 followers on Instagram and I was, you know, just this nerd kind of putting stuff out there. And now here I'm, and I'm on the Liz Moody podcast. Dreams do come true people.

Okay. Okay. So I'm fascinated by that whole story. It's beautiful, first of all. You're fascinated by my obsession with the Liz Moody podcast. Yeah, well, that too. I'm a Leo. So the more people like me, the more I like them.

Do you know that I'm a Leo? Did you know that? No, I didn't. Oh, my gosh. Oh, my gosh. I like you so much more. We're the best sign. And I think we're the only sign that would say we're the best sign.

confidently. That's true, but our pride is our, it's like one of our best features and it's also our downfall. One of our worst. Yeah. But so I, you say that you had, I love that you had the science and then also you have the personal story. And I'm always curious, we'll dive into people's questions in a second. But if you're not getting this stuff from your medical training, where are you getting the information that you're going to share with us today? And how are you validating it and telling that it's worthwhile information to share. Well, I think that there's a separate conversation that can occur about why traditional Western medicine is not talking about this stuff.

Now, here I am and I trained at the top institutions. I had, you know, literally the most famous GI doctors as my mentors. And so when I opened up my mind to the possibility that diet could be used to, you know, fix medical problems, when I opened my mind to that. possibility, I went to the medical literature and I thought, you know, there's probably like 10 or 15 pathetically weak studies that no one would care about. And that's all that's going to be there. And, you know, my guess is that this is probably just empirical and everyone's just kind of making it up. And then when I went to the medical literature, I was like, oh my gosh, there's not 10 or 15

studies. There's literally thousands of studies. Thousands. Why have I not heard. anything about this. And, you know, we're not talking about weak studies. We're talking about the, you know, most powerful evidence that exists. Systematic reviews and meta analyses, randomized control trials, large, multi-10,000 population-based studies, prospective cohorts. We're talking about great studies. And I feel like the science is there. The science is there. It's just that it's not being shared. And that's where I felt compelled to bring it into my clinic. I can't help it.

There are people who are in my field, who are in my community, who would look at the way that I practice medicine and say, you know, that's great, but guess who's making more money? That's how you feel? That's okay. I feel like I'm doing the right thing for my patients, and that's what matters. So to me, I felt like I had discovered this gem. And then it was just like one thing after another where first I brought it into my clinic and I'm seeing people being healed. And then I'm like, look, this is way too important to just be talking about it in the clinic. You have to, I felt compelled to share it.

And I know this sounds weird because I have over 80,000 followers on Instagram, but like, I am not a social media guy. I never had an account. I literally the only time I would ever post a Facebook. First of all, I didn't have an Instagram account. I didn't even know what it was. That's what the kids do, I guess. No, the kids do TikTok these days. Instagram's old now.

I'm not one of the old Instagram people. But like I had a Facebook account and like literally the only time I ever posted to Facebook is when the weather was nice down south and all my friends in Syracuse, New York. You know, I had to let them know suck us. Suck us. I'm barbecue and it's March. Yeah, exactly. So, like, I've never done anything, but there was something that compelled me to say,

you got to put this out there. And, you know, it was never the plan for that to grow. It was never, this was never a business plan. This was never, hey, I'm going to be a brand. This was, like, just completely organic. I felt compelled to put it out there. I started to put it out there. One thing happened, and then another thing happened.

The next thing, I know I'm getting some traction. And then in the summer of 2018, I had a pop. podcast that went viral and with Simon Hill from Plant Proof and when that happened, it was like, oh my gosh, like people are wigging out right now. And I felt like to podcast is great, but I felt like I need to bottle up this message and put it out there in a more powerful way. So that's when I decided I wanted to try to write a book. And now here we are.

And May 12th, Fiber Fueled is launching. throughout North America. So exciting. All right. So let's get into the questions. I feel like we've already sort of touched on why gut health matters via your personal story, which is incredible. And we'll get more into the weeds on that later.

But how do you know if your gut is healthy? And do you need to take tests to be able to find that out? Honestly, I feel. So first of all, let me say this. Gut health should matter to every single person who's listening to this podcast. I don't care who you are. You could think that you are the most healthy person in the United States of America. If you are, you want to protect that commodity.

Health is so important to your quality of life. Health is so important to, you know, what you're going to be able to do through the years as you age. You want to be able to age gracefully. So you want to protect that commodity. You want to optimize that commodity. And because gut health touches so many parts of our body, it's so much more than digestion. It touches our immune system, our immune system, our mom. metabolism, our hormonal balance, our mood, our brain, the way we think, even our genetic

expression. Does it directly impact longevity? Well, I mean, we have powerful studies with many of the foods that I advocate for that demonstrate, you know, enhanced longevity as a result of eating those foods. So, you know, is there a study where they look at gut health explicitly and then tie that to longevity? I haven't seen that yet, but I would expect the answer would be. yes that's what I would expect but again we you know I can't say that until the study is actually done but you know the bottom line is that we should all matter we should all care about this but how do you know how do you know whether or not your gut has been disrupted or damaged the most common thing is going to be digestive symptoms so gas bloating abdominal pain discomfort diarrhea constipation

acid reflux these are sort of of classic symptoms. Now, look, we all have issues from time to time. But if you have ongoing issues that are more chronic, then that indicates or suggests to me that there's more of a gut-related issue. But in chapter one in my book, I talk about all the different, first of all, symptoms that are connected to gut health, things like brain fog, and rashes, energy levels. And, you know, those can be clues too. Let me give me an example of is I also see how this ties systems together. It's not just the gut.

So I'm the GI doctor, but a person will come to my clinic and they'll have anxiety, depression, migraine headaches, thyroid disorder, asthma. And I look at that list and I go, I know you got a gut health issue. Every single one of those things that I just listed is tied back to gut health, every single one. So I don't actually use tests to determine whether or not a person has a gut health issue. It's quite obvious. And, you know, maybe it's because I'm a GI doctor, but it's quite obvious when a person is suffering with chronic digestive symptoms and then has all these other conditions that are associated with the gut. You know.

It just kind of becomes very obvious. What do you think about the like send away stool tests and stuff like that? Do you think those are worthwhile? I think they're fun. I think they're curious. I think they're interesting. I would make the argument that in 2020, where we stand today, they're not quite ready for prime time in the sense that they need to be clinically validated. So pretend a patient comes into my office and says, I have earoral bowel syndrome.

If I order the test, the test is going to give me information. Okay. That's interesting. but how do I know that I can use this information to actually improve the health of my patient? That's the question. And I need them to come forward with a study where they say, look, using the information from this test, we were able to show that you could clinically improve, you know, this condition, your bowel syndrome compared to the people who did not have this test.

That's what I need. And that hasn't been done yet. Got it. Okay. So I feel like bloating is. probably one of the most common gut issues that people suffer from. What are the common causes of bloating? Where does it come from? All right. So bloating tough, tough, tough, tough symptom because it is so widely prevalent and we lack great testing. But let me tell you the way that I think about this,

which is that there are four different things that can contribute to bloating. And it could be a combination of these four. And I always tell my patients when I'm talking to them, as I'm saying this, think about yourself and where it fits in for you. Because it could be one, could be all four. What do you think is going on? So the first thing is gas that gets into the body another way. People don't realize if gas gets in, it doesn't get absorbed. It has to either come out as a belch or it has to wiggle its way through your intestine, causing discomfort the entire way, and come out the other end as a fart. And that's like literally just from chewing gum or something like that would be ingesting gas, right?

You're good. Chewing gum, sucking on a Jolly Rancher or something like that, sucking through a straw. So if you think about the straw, half of it is underwater, but the top half of it is all air and you suck it down. Carbonated drinks seems so obvious. Yes. Yeah, sorry. You're busted. You're busted. And then the other thing that I'll often ask my patience is, do you ever get accused of like eating too fast or being an aggressive eater? Yes, my husband. He eats all of his food. And then I'm like a quarter of the way done with mine. And then he helps himself to all of mine because he's like, if you really wanted it, you would have finished it already. That sounds like an interesting dynamic in that household. But, you know, I love watching.

Like, it's kind of like when you're in Vegas, I like to, like, sit there and just watch people. I like watching aggressive eaters, but the problem is you don't want to actually be the aggressive eater because you swallow air. So, like, does your husband, I just got a curiosity, I don't mean to call him out on this podcast. Is he very farty? Well, is he belching a lot? He actually isn't, but he's also one of those weird humans who just seems to have, like, great health no matter what they do, you know? It's just, like, one of those perfect.

He's annoyingly, like, healthy and whatever. He's an Adonis. His name is Adonis. Yes. Nice. I like how you spun that to compliment him regardless. That was nice. And that's good for the marriage.

You know, it's like when I called to my wife an angel in the heavens part of it. So anyway, air that gets in needs to come out one way or the other. Okay. The person who says, for example, I belch like 30 times in a minute, they don't realize that's all air that's swallowed. They're swallowing air, belching, swalling air and belching. You look like I just blew your mind. Do you okay? No, it's just, it's really interesting.

Like I didn't, I didn't, it's, yeah, it feels very obvious, but I didn't think about it. And immediately my question is like, what air decides to come out your mouth versus what air decides to come out as a fart. Well, the air that comes out of your mouth, the reason why it doesn't smell like a fart is because it's just the air that you swallow down in your stomach and then it comes back up. When you have a fart, by the way, is that the proper terminology for this podcast? Are we okay with that? Yeah.

Yeah. I mean, you could say flatulence if you want to. sound fancy. Yeah, I didn't want to be like too clinical. So, okay. So when you have a fart, the reason why it's coming on at the other end is because most of our microbiome lives inside of our large intestine. And that's where the gas is produced, which, by the way, brings me to the other three causes of gas. Number one, motility. And bloating, right? Yeah, gas and bloating. Gas and bloating. So number one, so we talked about swallowed air. So next is altered motility, specifically constipation. The number one cause of

bloating, like the people who are like, hey, I woke up and my stomach was flat and then a couple hours later, it's distended like I'm pregnant. It's almost always constipation. And they may not realize it. They may be pooping every day and may not realize that they're still constipated because they're not completely emptying. So constipation because of altered motility. Third is the microbiome. If you've had damage to your microbiome, it affects the way that you process and digest your food, which can lead to more gas and bloating. So the person who, you know, took antibiotics for sinus issues like three times a year, or they're on antibiotics for acne, or, you know, acutane. There's all these different things that could potentially contribute.

Damage to the microbiome is the third thing. And then the fourth and final thing is your food. So there are certain foods that are more likely to be gas producing. It's no secret that beans are very gas producing. And that doesn't mean that it's a bad thing. That's actually a healthy part of our digestion. So now when it causes discomfort and bloating, that's a different issue. And it speaks to there being something more pathologic going on.

but in that setting, alterations of the diet can be made to potentially lead to improvement while you figure out what's going on and trying to get better. Okay, so we'll talk about prevention in a second. I feel like some of those are easier than others, like stop chewing gum and eat slower

and chew your food better and things like that. But let's say you just are experiencing bloating or gassiness or that sort of uncomfortable stomach sensation right now. Is there immediate things you can do in the moment to experience relief? Gosh, this is a great question. You have some good questions here. I'm impressed.

So a couple things that you can do. Believe it or not, in India, they have a tradition after meals. Have you ever been to an Indian restaurant and you see those seeds? Yeah. They're candy-coated usually, right? I guess it depends on which Indian restaurant you go to. The ones with the candy-coated ones, of course. That's the good restaurant.

Those are fennel seeds. And fennel, so fennel is very soothing to the greek. gut and helps with gas and bloating. And you can chew the fennel seeds and releases the oils. You can also prepare fennel tea, which can come in a tea bag. And that can be something you can do after meals. Pepperment is also very helpful. So you could do a peppermint tea. They have a product that's available at most drug stores called IB Guard, which is basically like, I'm kind of like, why didn't I think of that? Because literally all they did is took peppermint oil and put it into a delayed release capsule. Oh, that's smart. But yeah, so those are pretty smart. So those are things that

you can do. And then many times people feel better when they weigh down. When they lay down, they oftentimes will feel a little bit better. I do a thing when I feel really gassy and I like actually have pain from gas where I roll up a towel and I like roll my belly on that. And I don't even remember where I learned that. But is that a real? It feels like it helps. And sometimes it feels like when you like can't fart and you need to fart, it makes that happen. Is that a real thing? Or is that, Can you not manipulate your organs from the outside or can you? Look, when it comes to bloating and gas pain, like, I honestly, as long as you're not hurting yourself, if it makes you feel better, it's a win, right? Yeah.

So whether or not we have a clinical trial to prove that rolling up a towel and, you know, manipulating your abdomen with it is going to help your gas and bloating. I don't really care because you feel better and that's what I care about. Yeah, it's the worst. Honestly, that feeling when you have gas and you can't release it is like the worst pain. I have this distinctive memory being like maybe 10 years old and thinking I was dying and being like, I need to go to the hospital and then I just needed to fart. Like it's one of my most vivid childhood memories is being 100% sure I was like having an appendix issue and then I just needed to fart.

But yeah, it's one of the worst feelings of the world. Okay, so that's for bloating. Oh, wait. Go ahead. Well, and I was just going to say real quick. So I really want to emphasize the importance of constipation in this. Yeah, I was just going to get into that. Yeah, because I, you know, I'm laying out these four things,

but I want people to know that there's this, what I would call a vicious cycle that exists. Gas causes constipation, and constipation causes gas. So if you start to get backed up, you will start producing more gas. and then that will actually make you believe it or not more constipated. And it just kind of sends you down this path that you don't want to be on. And so with these patients, what I will often do is the key is I need to get them pooping. I need to get them into a rhythm. And what I found is, so, you know, as you know, is I encourage a, you know, a plant predominant diet.

And for my patients, I ultimately want to move them. in that direction of more plants. But the issue is that if they're constipated, it's not going to work. I need to get the constipation out of the way, no pun intended, before I can actually change their diet. And so the key for me is that I want to get them into a rhythm and get them pooping, keep things moving through. And so I will typically look for ways. And of course, this is not medical advice. I'm not, you know, I'm not telling people, like you have to talk to your doctor about this.

But typically what I'll do is I will first evacuate their bowels. So I'll have them drink a bottle of magnesium citrate and that will give them two, three, four bowel movements. Get a fresh start. People do that and oftentimes they're like, dang, I feel pretty good. And then I'll chase that with a daily routine. The key is the maintenance that's there to keep things moving. You don't want start, stop, stop. You don't want to wait until there's a problem.

You want to have something that you're doing every day and just maintaining it. And that'll often be magnesium that they do before bedtime. Magnesium, good for the bowels, keeps things moving. Good for migraine headaches. Good for anxiety. Good for insomnia. And you like citrate? Because I take lysinate because of how studied it is for anxiety.

But I know that that's not the best one for elimination. There is no best or worst, truly, from my mind. perspective. So I do citrate because that's what's readily available in the form that I need to get them multiple bowel movements all at once. The difference, the way it works, Liz, you're bringing up a great point, is that, so glycinate is absorbed more easily. And so when you want the magnesium in your blood, that's when you do things like glycinate. To get the bowel movement, what you need to do is you need to actually overwhelm your gut's ability to absorb the magnesium. by taking a certain amount of it all at once.

And when you do that, it will draw water into the colon and then flush through. So it'll do that with any type, but the citrate is less absorbed, so it'll do it faster than the glycinate might. Exactly, or the sulfate. So the citrate and the sulfate tends to not be absorbed as easily as the glycinate. But, you know, you could do it with any type, and it really doesn't matter. You know, it's kind of like calm. Many people know calm magnesium. Yeah.

they'll take that before bedtime. There's nothing really special about calm magnesium. It's just a novel way to get your magnesium. It helps with sleep and it may help you to poop too. Okay. So you, the daily routine includes magnesium. What else does like our daily pooping routine include? All right. So you know what? Let me let me give you three additional things, but I'm going to give you really it's magnesium before bedtime and then it's a daily prebiotic supplement. So I tend to, let me say this, I am not like endorsing any product or brand. I have no relationships. Okay.

But I am a believer in prebiotics. I wrote an entire chapter in my book fiber field about them. And so the most readily available is wheat dextrin. If you have celiac disease, I would not use it. But it's actually completely natural plant based and it's available as Benafiber in the United States. You can get it, anyone can get it like literally today if you want to. it will dissolve in your coffee.

That's what I like about prebiotics. You could also get acacia powder. You can get that organic. You might be able to find that at Whole Foods or your natural food store. You could get guargum. And then two other prebiotics that I like, but you can't get them in powder form. You have to get them in a capsule form. Beta Glucan, which, by the way, is great for the immune system.

And gluca manon. Now, I made a mistake with Guka Manen a couple years ago. I bought powder and I put it in my coffee and then my coffee turned into gelatin. And I like turned the cup upside down and start shaking it and it wouldn't come out. So I had to get a spoon to scoop it out like jello. And you still ate it? You're still like, this is appetizing. No, I didn't.

Okay, fine, I did. Okay, fine, I did. It busted it. So the point is, though, that prebiotic fiber is soluble fiber. That means it dissolves in the beverage. But that's nothing to say about the viscosity of it. So glucaban and beta glucan are very viscous. They'll make things thick.

Whereas wheat dextrin or acacia or guargum, they don't thicken as much. So, okay, so magnesium before bedtime, pre-botic fiber, I like to put in my coffee. That's what I do every day. And then two little lifestyle things, this like perhaps sounds so childish. It's like potty training a child. But if you sit on the toilet the same time every day, you will form a habit. And so it goes like this. Maybe this is TMI, but let me just put it out there.

You guys can do whatever you want with it. There's no such thing on this podcast. Okay, cool. So you better be careful. I'm a gastroenterologist. I will really cut loose on that. All right. So I am used to having an alarm go off at six in the morning. And so the alarm goes off. You go to the bathroom. You pee. You jump in the shower, right? Saturday morning, your alarm does not go off. It's amazing how your body will wake you up to pee within five minutes of six o'clock because you've trained to yourself to do this. You can train yourself to poop at the same time every day.

So what you do is you sit on the toilet for five minutes. Don't strain. Don't push. Don't force it. If five minutes go by and you don't go, just leave. But if you do this at the same time every day, your body will actually pick up on what you're trying to do. And then the fourth part is the squatty potty.

I was just going to ask about that. That's in my quick fire section. I have one. It's so easy. You know what? You can get the branded one and support them. They have a great name. bucks yeah they're not that expensive not that expensive or you can or you can just like have a box or a stool

you know that you put your feet up so and it's because we were the the concept of the toilet and sitting on it like it's a throne is not physiologic we were meant to sit in a squat position that's the way that we've always pooped throughout human history prior to very recently and there's actually a muscle called the pubo the pubic oxygen is that's like a sling muscle that the bottom line is this it doesn't fully straighten out your rectum unless you're in a squatted position so if you look at what's happening inside your body when you're not in a squatted position you're not actually as ideally positioned as you should be to poop so getting your legs up can help and and you know I guess I should add in

for extra credit drink a lot of water and exercise is great like literally really a walk after dinner can help. I do. Drinking a lot of water is interesting. I need to be better at this, but I was traveling in Colorado in November, and I drank so much water because of the altitude. And it's the first time I've taken a trip and had zero constipation issues because usually I feel like when I fly, when I travel, I just always get a little funky in my gut.

And I was chugging water and pooping beautifully. So I don't know if there's like a concrete connection there. It's a one. That sounds amazing. is my dream vacation. That's all I needed. I didn't even have to leave my hotel room. But it was definitely a noticeable thing for sure.

Are there certain foods that people eat that they should maybe not eat that cause bloating? You've talked a little bit about how beans cause bloating or I know cruciferous vegetables do for me. But those are good for me and they're sort of good bloating. Are there foods that maybe everybody should universally eliminate that cause bloating? So, okay, so this is a good question. I would like to frame it this way. When a person comes in and says, I'm having a lot of gas and bloating, the first two questions out of my mouth are how much milk do you drink or how much dairy do you consume?

And then the second one is going to be, do you use artificial sweeteners? Because those are all extremely gas-producing, and you would be shocked. at how many people can just get rid of dairy or get rid of the artificial sweeteners and then make radical recovery. Dairy is my, it was, so I used to drink tea with like a lot of milk in it. And then when Zach and I started dating, I went through a period where I'd like wake up to myself farting in the middle of the night. And I was just like, I can't have this with my new boyfriend.

And so I cut dairy out and I completely stopped farting, which was wonderful. And now you're married to the. Donas. It's wonderful. Yeah, we both, we both have stories that our love stories end with our gut health getting in check. So it works. There you go. That's the way that it worked for me too. What about the artificial sweeteners of the natural sort? Like, how do you feel about stevia, monk fruit, and those types of things? I mean, I don't, so like, I don't see, I don't view those things as being health promoting per se, but stevia, monk fruit, and erythritol, when you need a sweetener, I feel like they're fairer game, you know, just consumed in moderation. And then I would also

add that, you know, things like molasses and maple syrup and things of that variety are fairer game too. You know, I mean, it's not something that you want to seek out and get more of, but when you're opting for a sweetener, that's where to go. Okay. And what about, it's really interesting to me that you mentioned guar gum earlier because a lot of people, I'm thinking of a number of influencers who promote gut health sort of issues, like conquering gut health issues, they always say get rid of all the gums and those types of things, and they point them out when they're on labels and things like that. So what is the deal with those gums?

I think what they're referring to is when you take, like, you can take anything, you can take seaweed, which is in its whole food form, completely natural and healthy. And then becomes caragana. Exactly. And you can isolate things from it and create issues, right? And so there are ways that we can take virtually. I'm sure there's a way that I could take kale and isolate something in kale and make it horrible for people.

You know? So when it's being used as a binding agent within processed foods, look, who's advocating for more processed foods these days? I mean, so I feel like it's sort of a moot point in a way. I'm talking about a fiber supplement, which is a little. bit different from my perspective. Just not to play devil's advocate, but just to kind of recognize what people's lives are like, I do think that nobody's advocating for processed food, but people do sometimes need to fit processed food into their daily life.

Is that something that you would universally recommend looking at the label and sort of having be like a no-go? Or is it fine for you to see those types of things on an ingredient label? Okay. So this is so, this is so, it's so tough, honestly. this kind of topic. So let me unpack it a little bit if that's okay. Because the issue is we all eat processed food.

And like I do too. No one, I don't think anyone is perfect when it comes to this kind of stuff. I think the goal is really to try to minimize. And, you know, it's hard for me to say, hey, here are the explicit like no-go, you know, chemicals that I recommend that you check your label. There are literally, like, I don't know if you realize this list. literally 10,000 additives approved by the FDA, 10,000 food additives. Less than 20% of them have had any human testing at all. And the human testing that's been done, the human testing that's been done is like,

oh, they ate this for seven days and they were okay. Well, that tells me nothing about what happens if I eat it for 10 years. We're never going to have that kind of data. So I think that the best case, the best way to approach this, and again, like, I am not perfect, I eat processed food too. But it's really, I think that the goal is to say, we're going to try to minimize processed food to the best of our ability. We're trying to mostly shop on the outside of the supermarket where you have the fresh stuff and try to stay away as much as you can, the center aisles where it's the packages and the bags and the boxes and that kind of stuff. So I personally don't feel like, hey, here's the processed food that's good. And here's the, I know there are people that create these lists.

I don't really feel compelled to say, here are the ones that are good. Here are the ones that are bad. I feel more compelled to say, look, we really want to moderate this as much as possible. I don't want to get into the business of fear mongering each individual label or ingredient. When frankly, most of the time, we just don't know. Honestly, we just don't know. That's fair. You're listening to the Healthier Together podcast.

If you're listening to this episode, then you're clearly interested in gut health. And Garden of Life has been one of my favorite brands for supporting my own gut health for years. We talk about how great magnesium is for clearing you out and supporting your digestion. And I love Garden of Life's Whole Food magnesium chelate, which is non-GMO, vegan, gluten-free, organic, all of the good stuff. It comes in raspberry lemon and orange. Both are really good, but I slightly prefer the raspberry lemon, although honestly it depends on the night. And you can drink it at night to help with sleep, anxiety, and really keep. keeping your digestion moving.

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organic apple peel, and organic cranberry fruit. And that is it. I either add it to my smoothies or I'll mix it up in a little bit of water to form a slurry and then I'll add more water and chug it down, which helps it not clump and it tastes really good. And I just love it. You can find Garden of Life products on Amazon or at your local Whole Foods, but the best way to support this podcast is to use my affiliate links. It doesn't cost you anything extra and it just lets Garden of Life know where you found them.

I'll share a whole gut health highlight on my Instagram stories at Liz Moody, and I'll put swipe up links to these supplements and a bunch of other gut health info. And you can also use links in the description of this podcast episode. I super appreciate it, and I know that you're going to have your life changed by these products. All right, let's get back to the episode. Let's talk about gut health and hormones. How do people's guts impact their hormones? And I want to include things like hormonal acne or a lot of people have different, gut issues around their different times of their menstrual cycle.

So what's the relationship with that? And if people feel like that's out of balance, are there different things you can do for your gut to get your hormones in check? Good. So it is very, very well recognized that during the monthly fluctuations of the menstrual cycle, digestive symptoms can vary. And so we know that your oral bowel syndrome can flare, you know, basically during different phases of the menstrual cycle.

The question is, like, do you need to adapt your diet during these particular times? That's, to me, a very individualized thing. I will have some patients who come in where it's very, very clear cut, hey, I feel great except for this particular week. Like, the week leading up to my period is the week that I feel horrible. And so many times for that particular patient, we will create modifications of what they will do during that period of time to get themselves feeling better. When it comes to the hormones itself, there is, there's a clear-cut connection between our gut and our hormonal balance.

And, you know, our gut is really truly an endocrine organ. We can think of our gut in the same way that we think about our ovaries or our testicles. And one of the major ways that it contributes to our hormonal balance is actually estrogen balance. It activates estrogen. There is an enzyme produced by the gut bacteria called beta glucuronidase. And beta glucauronidase basically controls how much estrogen gets activated as opposed to getting excreted through our stool. And so what's interesting is that you see conditions of estrogen excess associated universally with damage to the gut.

So what I'm talking about is I'm talking about endometriosis, endometrial hyperplasia, ovarian cancer, endometrial cancer, and breast cancer. All of these conditions have been tied back to gut health. When they study these conditions, they discover that there's alterations of the gut. And the theory or the belief is that it comes back to this balance of estrogen where the gut microbes are behaving similar to a dam and they basically have their hand on the lever to control the floodgate.

So you can wet too much water run downstream and you can flood, or you can wet too little run downstream. And there's another condition that's associated with damage to the gut where you have in some cases less estrogen, but even more than that you have a dominance of androgen and that is polycystic ovary syndrome.

Polycystic ovary syndrome has also been connected back to the gut. And what's interesting is that not just estrogen, but androgen production, androgen production, meaning like male sex hormones, which we all have, has been connected to a specific bacteria called chlostridium synthins. So the balance of this bacteria could potentially affect the androgen production, which we know that polycystic ovary syndrome is increasingly more common today than it used to be.

Yeah, endo is as well. If somebody suspects that gut issues are at the root of their hormonal issues, is there some sort of low-hanging fruit that they could do at home to help get that back in balance? So I feel like the path, there's no super quick fix. because at the end of the day, our gut health is a reflection of a combination predominantly of our diet and our lifestyle. There are some parts that you have no control over, like what you inherited from your family or your genetics. Like you can't control that. But your diet and your lifestyle you can control.

And our studies show that you can change and improve your gut by taking care of those things. I think the important thing is this. this is the way that I feel compelled to answer your question. You can't take a C minus gut and take some supplements and turn it into an A plus. It's just not going to happen. You have to be prepared to walk the path towards better gut health. And to me, I feel like my book, you know, is that path. I mean, you know, I prepared the book grounded in science over 600 references.

And I feel like this is, I'm showing people the way to, to walk towards better gut health. It's not meant to be one size fits all. It's actually meant to be completely individualized. It's meant to meet you where you are and just help like basically get you that compass. So you can point yourself in the direction. Okay, here's where I need to go now. And that to me is how you get it back. And in my book, I have a four week plan.

And it's a four week meal plan. We have, we have 80 recipes. The reason why. why I opted for four weeks. I'm just going to say like it would have been so much easier to do a 10-day thing and call it a detox. But study after study after study as I was researching my book was showing me that four weeks really seems to be the magic number. And so I had to make it a four-week plan. It doesn't mean if you have a damaged gut, then in four weeks you will fix all your problems. Like, gosh, I would love that to be true. That's one menstrual cycle, you know. But, um,

But what it does mean is that I do believe that you can radically transform your gut health in four weeks. And I feel like my meal plan could be part of that process that helps you as you transform your lifestyle and get moving in that direction. So you said diet and lifestyle. So what's like three foods? If you had to pick three foods for everybody to incorporate into their diet every day, what would those three foods be? That would be just like awesome for gut health. Oh, gosh. All right.

So I feel like before I jump into this, I have to say this. And I think you know this about me, Liz, but I want to share it with your with your posse. There, to me, there is something more important than superfoods. There's something more important than fixating on specific foods. And that is the diversity within your diet. All right. So, and the reason why I say this is because there was a study, it's called the American Gut Project.

It's actually an international study, more than 150 countries involved. And it is the most well-positioned study that we have to allow us to connect diet and lifestyle to the health of our gut microbiome. And when they analyzed the data, out came the clear-cut number one predictor of a healthy gut microbiome. And that was the diversity of plants in our diet. So, and I'm happy to unpack that general idea a little bit more later on in the podcast. I'm sure we'll come to an opportunity to do that. But what I like to say is, I want you to have as many friends as possible.

I want you to have that diversity. But it's okay to invest into the superfoods as your best friends. It's okay to have certain ones that you say, look, these are the foods that I feel like are above the rest. Now, it's hard for me to just give you three. I wrote a chapter where I give an acronym F-goles, F-goals, and these are my foundational foods. So let me just run through real quick, and if you have questions about any specific category, I could unpack more. But F-goals stands for fruit and fermented, greens and grains, meaning whole grains, not refined grains.

Omega-3 supersedes like chia, flax, hemp. Aramatics, like onions, garlic, leeks. shallots. You also could have called that aliums. Or aliums, exactly. Legumes. So, beans, lentils. And then S, probably my favorite out of all of them. It's a little bit weird. Sulfurafane, which refers to broccoli sprouts or the cruciferous vegetables, because sulfurous vegetables because sulfurophane is an absolute cancer crusher. But I did also put two bonus ones in there because I just couldn't let it go. I had to put them in there somewhere.

Shrooms and seaweed. Okay, so that's my list. Fruit and fermented, greens and grains, omega-3 supersedes, allium, legumes, sulfurane, shrooms and seaweed. And that, to me, is the foundation. Some people are going to look at that and go, whoa, but when I eat garlic, I feel horrible. or when I have beans, I feel horrible. And that's okay.

Part of what I'm trying to do with my book is to broaden your diversity and help you to understand what's happening when you have food sensitivity and have an action plan for how to address it. And so I have an entire chapter, chapter five, probably the most important chapter in my whole book, is how to find your plant passion with a sensitive gut, trying to guide people to a better place so they can enjoy all these foods without restriction and get back to rocking again. Okay. So I have to ask, what are your thoughts on lectins? So, you know, I think what it comes down to is this. When you hear competing opinions and everyone

is saying, but I have studies to back up what I'm saying, we're creating a lot of confusion for people. And I regret that. And I feel like people deserve better. So one of the things that I did to address this, and by the way, I'm going to answer your question. I apologize for the tangent here. But one of the things that I did is I mentioned that I have 600 references in my book. It was so much that it was adding 50 pages. So we had to actually take it out of the physical book because my publisher was like, look, it's getting too thick. So I'm putting it on my website, the plantfedgut.com. And I'm including with the 600 references, which by the way, you can buy the book or not buy the book, but I'll give you this for free.

I'm including with it a research guide. And it's meant to give people the foundational understanding of research so that when they see conflicting opinions, they can start to have an idea of how to navigate that. And the key here is this. There is a hierarchy to research. And this is universally agreed upon by scientists. at the top are systematic reviews and meta-analyses. It basically means that you are organizing the research, you're doing a thorough search, and you're compiling the data.

That's a systematic review and meta-analysis. Below that are randomized control trials. Below that are large population-based studies, like cohort studies. At the absolute bottom of the hierarchy are anecdotes, which means like, hey, my uncle drank a 12-pack a day and smoke two packs a day and you live till he was 95. So that's what I'm going to do. Okay, that's an anecdote.

That's not the way it works for most people. And below that are laboratory studies, pre-clinical studies. Examples are animal studies or where you take something and you put into a test tube, some unnatural thing in an unnatural environment and you stir it up and you see what happens. The problem with the lectin idea is that when you look at the pre-clin studies, you see something that's problematic. But the problem is pre-clinical studies like test tube studies should always be verified in human populations.

If you don't verify them, you're going to come up with bad ideas. They're going to lead you in a wrong direction. So you have to go to the human studies and ask the question. So if lectins are a problem, what happens when people eat beans? And what the population-based studies say is that people live longer with less than with less heart disease, and with less cancer, which, by the way, those are the top two causes of death. And when you look at the microbiome, people will say, well, what about the microbiome? Is it causing harm? Is it causing dysbiosis or a leaky gut? So you go to the microbiome studies.

What happens when people actually eat beans and then we test the microbiome? We see the microbiome gets stronger because they're an excellent source of resistant starch and prebiotic fiber. Okay, what about inflammation? Do people get inflammation? In the inflammation, in the inflammation, The inflammation studies, the inflammation goes down. So the problem is that these ideas are not checking out when we actually apply them to real human populations. When you give me something an idea that comes from laboratory studies, I need to verify it in human populations. I want to know what really happens. And by the way, this is a lot of this, it's a broader, bigger, more nuanced conversation.

But with gluten, a lot of the same ideas that I'm referring to apply, which is that If you just look at pre-clinical studies, which are not human studies, or they're human in a test tube studies, you see something. But then when you go to a verified in human populations, you see something different. And at the end of the day, when there's a discrepancy, you have to look at the big picture and accept the higher quality evidence. And the higher quality evidence suggests that when people eat beans, they live longer with less heart disease and less cancer. I mean, all five blue zones, that's what they eat. What about the idea that in the blue zone, so they're preparing the beans in a more historical way where they're getting rid of the lectins by the process of soaking and sprouting and all of that and things that we're not doing in our modern lives? If you want to soak and sprout your beans, I'm totally cool with that.

I want to. But I'm like never going to be the person who does. So I want to know realistically how bad it is for me to not do that. All right. So out of curiosity, out of curiosity with you, do you get dry, do you buy dry beans or do you buy canned? I buy dry beans and canned and then the dry beans sit in my pantry for like three or four months and the canned beans get eaten within a week. Cool. So the canned beans have already, have already been cooked at high heat, not necessarily pressure cooked. Well, the brand I buy actually does pressure cook, eating organic. There are some brands that do that. And they cook them with combo, which I like as well. Perfect. So the lectins are gone in those. Right. But do you think that's important, you know, to have that pressure cooked property? I personally don't. I mean, I don't, I personally don't think about that at all. I personally don't think about that. I think that our beans need to be cooked.

Right. And when, right? Well, so, I mean, I feel like that seems so obvious. But the funny thing is, like, I don't know if you've ever heard this, but there are two examples where lectins actually did cause. significant issues that have been documented. Have you heard about this? No. Okay. I really hope it's not somebody eating like uncooked beans. Oh, man, you just stole my thunder all that, but that's okay. I'll still tell the story.

So there is a report from, and you can, this is literally written up in the medical literature, people can go and look it up if they want to. There's a report from 19, I think it was 88, where there was a party in a hospital. of all like ironically of all places and someone served a dish with undercooked beans and people got sick yeah people got sick and that was because of the lectins there was a um also there was a report uh in the early 2000s i believe out of japan where someone on television said hey go get this bean powder. And the key is that it was a dry bean that had been basically like, you know, chopped up a bazillion times into a powder. So it wasn't cooked. And so people went and bought this

bean powder and then like on mass scale who were watching this television station, they got sick. Now, what does get sick mean? I mean, that literally means that they had diarrhea and by the next day they were fine. All right. We're not talking about life-threatening illness here. We're not talking about something that's irreversible. And we're talking about something that we chuckle about years later and there's two incidents in human history right and meanwhile we have how many hundreds of thousands of people dying of heart disease on a yearly basis and how many people dying of cancer over year and this is one of the foods that most powerfully can protect us from those conditions and we need to consider that so you so cooking beans in any way reduces lectins is pressure cooking sort of the gold

standard for that or it's just like you're like any beans cooked in any way the lectins are at a point where they're negligible compared to the health benefits you're getting from them. So first of all, to be fair, the counter argument, if you actually go and people can do this, you know, if you're interested in this, like you don't have to be a medical doctor to do this. Go to PubMed and search for lectins. And what you're going to find is that more than 50% of the articles that are published are actually about the health benefits of lectins. They have anti-cancer properties.

I realize that argument hasn't really been shared as much as the, you know, sort of theory of how harmful they can be. But there's clear-cut studies that suggest that lectins have anti-cancer properties. So that's part of the counter argument. Like to say, let's get rid of all the lectins, maybe there's benefit. I mean, people are getting cancer. Maybe there's benefit to lectins. With regard to your question, you know, to me, to me, I personally have never used a pressure cooker in my entire life. And I eat a ton of beans, a ton. If you feel compelled to do that, you certainly can. And I don't think that there's anything wrong with that. But when we look at the data and you actually just cook your beans, like boil them, when you boil your beans,

you're reducing lectins by 99%. Joe, maybe you're just getting like a little bit of goodness and none of the badness of that. Well, that's the thing. What are we talking? Is it good? Is it bad like what is it i mean that's the problem i think it's so interesting this is this is this is where you know to me one of the big points of my book and what i want to get out there to people is this i i worry about these ideas that are creating a division between us and our food i worry about you know when we vilify our food and we turn it into food monsters whether it's lectins whether it's gluten i mean we can talk about gluten if you want to i guess i'm i'm alluding to it much or probably need to.

Yeah, I'd like to talk about it briefly. Okay. But like, you know, whether it's lectins or gluten or phytates or oxalates or whatever it may be, whatever it may be. I mean, honestly, even with me, it's like we're turning our food into monsters in a way that creates separation between us and them and can create, like, disordered eating. And that disordered eating could be mild. It could be like, okay, I'm a little uneasy about eating this food.

And, you know, ironically, when you become uneasy about eating the food, you are far more likely to have symptoms when you eat that food. Okay. Or it can move along that spectrum where you get to a place where it's full on orthorexia. And I have seen cases, many, where people go down this path of restrictive eating and end up with anorexia or bulimia. And so I feel like we deserve to get back to a place where we have a healthy, relationship with our food where rather than having laundry lists of avoidance, rather than having things that we have vilified and turned into monsters, I feel like we deserve to get to a place where we are celebrating the beneficial qualities of our food and rather than running away,

we're running towards and we're embracing. I think the stress thing is so real too. So many people will be like, oh, I go to Europe and I'm on vacation and I can suddenly eat gluten and it used to irritate my gut so much. and they'll talk about how it's, you know, ancient grains and stuff there. And I think that's true to an extent, although less and less so over the years. But I think the huge difference is the fact that they're on vacation. So they're not stressed.

So they're eating in an environment. They're sitting at a table in a square without being watching TV or doing something up, being on their phone and eating. And they're digesting their food so much better simply because they've eliminated so much stress. Like I think it has, in a lot of ways, less to do with what you're eating rather than how you're eating what you're eating. like that's like you and your and your glorious epic bowel movements in Colorado that we've been talking about. Yeah. No, it's true. It's interesting. So do you, I completely agree. And that's like my philosophy

towards food in general. And also I'm a big believer in instead of cutting out any category of food, just crowding it out. Like the more you eat veggies, the more full you are and you don't want to sit any fruity pebbles. But, which is my favorite junk food, by the way. It's eating the rainbow, you know it's good for you um but in it for the gluten conversation like do you believe that it's better to diversify your grains do you think that white rice or um or brown rice is better sourdough fermented breads like do you look for anything when you're eating carby type food yeah so um let me say okay a couple things first of all i would not advocate for a like predominantly gluten-containing diet right like i'm not sitting here saying you should get more gluten in as much as possible

number two i think it's entirely possible to go gluten-free and be extremely healthy i think it's entirely possible but the issue is that most people don't understand exactly how to do it because they're not a nutritionist if you consult with a nutritionist they can help you to accomplish this you know someone like you knows how to do this list but a lot of people people do not. And so the issue that I see is that it's become such a trend to go gluten-free, people who don't need to go gluten-free or go gluten-free. And what we see in our studies is that people who go gluten-free are increasing the risk of heart disease. And that's the number one killer. And the concern is that whole grains protect us from heart disease. And wheat,

like it or not, is the number one source of whole grains in the American diet. So what I work about is it's not so much that gluten is good. It's more so that we're throwing the baby out with the bathwater because we're throwing away the number one source of whole grains and then we're not replacing it because we're not being intent. Now, I said before, you can be healthy and be gluten-free. So if you want to be gluten-free, there is quinoa, sorghum, taff, there's all of these other gluten-free grains that you can make a concerted effort to get into your diet and make sure that you are protecting yourself from heart disease. You should be having, you know, a dish, one of those dishes a couple times a week as far as I'm concerned. With gluten itself,

the issue is this. I think most forms of gluten are trash. That's because they're all processed. But the forms like sourdough and Ezekiel bread, that's where the money is at. You don't want to go overboard. It's still in moderation, but I feel like there's a place to keep those within your diet. Especially because I think they make people really happy. Oh, they definitely do. And you know, the other thing, I have to share this with you because I think you'll appreciate it. It's so, I find this to be so interesting. So first of all, I think most people on listening to your show probably already know this. If you have celiac disease, you need to be gluten free. There is no like partial to me. I get pissed at my patients. I like I get angry with my patients. If they

have celiac disease and they consume gluten because they could develop small bowel cancer and that is universally fatal when that happens. So if you have celiac, you have to be gluten free. But if you prove that a person does not have celiac disease and they get symptoms when they eat gluten-containing foods, we have labeled this, we have labeled this gluten sensitivity. And it's interesting because I think it's completely misnamed. It's completely misnamed. So they did a study and they took people who they proved were not celiac and they had gluten sensitivity and they gave them for three weeks a breakfast bar to eat. Every day they would have one of these bars and it was one of three bars.

Placebo, gluten, or it would contain fructans, which are a part of wheat and they actually are, believe it or not prebiotic, but they are a FODMAP. They're a FODMAP. So if you've heard of the FODMAP diet, this is one of the FODMAPs. You also find them in other grains and you'll find them in onions and garlic. They've measured their symptoms every day. And then they averaged out to say, okay, what caused symptoms in these patients who have gluten sensitivity?

When they looked at gluten, I mean, it's kind of amazing that this is the case. the placebo caused more symptoms than the gluten did. The gluten caused zero symptoms. Okay, so each person, like, rated their symptoms, right? Yeah, yeah. So you might say, my symptoms today are a four out of ten, right? So then they averaged that over the course of the week. The point is that people, when they were eating the gluten, the placebo,

were having more symptoms than when they ate the gluten. Okay, so what are your thoughts on that? It basically suggests that the gluten is not the cause of the symptoms. Are Fodmaps the cause of your symptoms then? Bingo. You just hit it. So when they ate the fructan bar, because fructans are also in wheat. So gluten-containing products, which are wheat products, also contain fructans.

So people who feel as if they have gluten sensitivities might, in fact, have FodMap sensitivities. It's a sensitivity to the FodMap, not to the gluten. The fructan triggered them. Interesting. That's super interesting. Okay, so let's talk about FODMAPs briefly because FodMaps also include things like apples and garlic and other, you know, plant-based foods that I would consider really, really good for you. If you feel that you are intolerant to FodMaps, is there a diet that you can just kind of follow and cure that? And then you can go back to eating those things. Is it you're done for life? What's the deal? You are definitely not done for life. You are definitely not done for life. So the major mistake that people make with the FODMAP diet is that I guess let me take a step back first and weigh the foundation by talking about FODMAPs a little bit. So FODMAPs are a part of our food, which is fermentable by our gut microbes, okay, meaning that it could potentially cause gas or GI distress.

Now, I'm making them sound really bad when, in fact, they're actually incredibly healthy. Most FODMAPs are prebiotic, meaning they feed the microbiome. And FodMaps include lactose from dairy, fructose, which you'll find in many fruits, fructans, which we were just talking about with grains and also with allium, vegetables,

galactans, which you'll find in beans. And finally, sugar alcohols, which you'll find in some fruits and also artificial sweeteners. So those are the Fodmaps. The way that many people have interpreted the low-fod-map diet is a misinterpretation of the intent. People will hear, oh, these foods are a problem. Therefore, I need to eliminate them.

And they will permanently go low-fodmap. And when they do that, our microbiome studies are very clear. You know, as I said before, diversity of plants is the greatest predictor of a healthy gut microbiome. and when you start to eliminate foods, the studies, whether it's gluten or whether it's Fodmaps, the studies are very clear. It causes harm to the microbiome. So when people go low Fodemap, they're damaging their gut and they make themselves actually worse off in the process.

The low Fodemap diet was developed at Monash University in Australia. The point of it was temporary elimination. Temporary elimination is not a problem. You can do it for a period of time, a couple weeks. Temporary elimination. And then reintroduction, progress. of reintroduction until you identify a threshold. And when you identify the threshold, you move towards trying to keep yourself below that

threshold. So here's the key. I like to, and this is a broader conversation on food sensitivity, and this is a big part of what my book is about. The gut is like a muscle. It can be trained. It can be strengthened. But if you stop using it, it will grow weaker.

So when it comes to these foods, let's pretend that you find that you're sensitive to beans, right? You can make a very strong argument. It's the galactans, the fodmap, in beans. All right, here's the thing. Just like with exercise, there is a certain threshold that you are capable of. If I go to the gym and I lift three times my normal amount, I'm going to hurt myself. Don't go for the four bean chili if you're not used to eating beans or if beans cause trouble.

Like, that's not a good idea. But there is a threshold where if you stay below that threshold and you introduce beans in the right amount of moderation, just like with exercise, the right amount of exercise puts the right amount of stress on your body. We call it you stress. You get the right amount of stress that actually is healthy stress and it makes you stronger and you get better as a result of it. When you consume beans in moderation, they should not cause.

Now, moderation may be very small for some people. It may be a really minimal amount. But they should not cause GI symptoms when you have the right amount, and it will contribute to you getting stronger so that you can do more over the course of time. So if you feel like you're intolerant to any food, would your recommendation be to eliminate it for a few weeks and then just start bringing it back in small amounts until you find your individual threshold? You could do it that way.

you could do it in consultation with a nutritionist or a dietitian, which many times if there's a level of complexity is necessary and important. And you could also try not eliminating. There's no requirement to take a break. To take a break. Yeah, there's no requirement to do that. So you could try not eliminating and just really be conscious of, okay, here's where my food sensitivity lies. You know, this is the type of food that I have trouble with and therefore I'm going to really significantly we moderate it, but I'm going to keep it around. So for those people who say had the problems with the FodMap bars during the study, you would keep garlic and aliums and stuff like that and beans in their diet,

but you would just cut back on the FodMap containing foods until they didn't feel any digestive distress and then work your way up from there. Exactly. And take it super slow and recognize that just like with exercise, there's some discomfort, just like with rehab, all right? So, you know, to make another analogy, you hurt your knee. Okay. You're out in Colorado.

You're pooping all over the place. And then you mess up your knee when you're skiing. Okay. And, you know, you mess up your knee and you have two choices, right? You can rehab the knee and you know there's going to be some pain with that. You're trying to bring your knee back. Or the alternative choice, which no one in the right mind would ever do, is the to say, oh, well, I don't want to ever feel that pain, so I'm going to stop walking because

I hurt my knee, right? The only way to guarantee that you never feel that pain is to stop walking. But if you stop walking, you become debilitated, your muscles throughout your body, start to break down, you gain weight, you gain adipose tissue, your blood pressure and diabetes kick in, and now you're way less healthy than when you started. The best path is rehab the knee, get it back, get it strong, and get back to skiing again. Maybe it takes it a year, but you get there. And that's true with the gut too is that, you know, I'm not going to say, I'm not saying,

just to be clear, I'm not sitting here and saying, hey, just like, just grin and bear it, like be tougher. I'm not saying that. What I am saying is that you should expect that when you have a damaged gut and you're trying to make it strong again, there's a process you're going to go through of rehabbing it. And it's not always going to go perfect and easy. And you just bounce back and you adjust and you keep moving forward. You're listening to the Healthier Together podcast.

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Again, that is go macro.com using the code healthier together 30. I cannot wait to hear what you think. Now, let's get back to the episode. Okay. you talk about alcohol for a second? Yeah. Are there alcohols that are... I'm just kidding.

It is two in the afternoon as we record this podcast for reference. I'm a medical doctor. Whoops. Sorry about that. I'm kidding, folks. Are there alcohols that are better or worse for the gut? Do you need to sort of mostly be sober in an ideal world if you're going for optimal gut health?

So let me preface everything by saying that I enjoy having a great spicy IP. PA once in a while, I enjoy sharing a bottle of red wine with my wife. But when you look explicitly at the science, I don't see advantages to the gut in terms of alcohol consumption. For example, you know, when we look at people who develop cirrhosis of the liver or fatty liver related to alcohol or alcoholic hepatitis, what we universally find in all of these conditions is damage to the gut microbiome. it's very clear that alcohol consumption to an excess will destroy the microbiome.

Like, I'm honestly, you know, maybe this is why I gained so much weight when I turned 30 is like I was paying the price for what I did in college. But it was a lot of, you know, it was like the late 90s. So I was listening a lot of juvenile back that ass up. I love how you're like, it was the late 90s. So I drank a lot in college and I just like everybody drank a lot in college. That's sort of the college experience. I want to take the opportunity to give a shout out to juvenile, back that ass up.

Of course. So the question is, is there a threshold where it actually is advantageous? And I don't believe based upon the available studies that I've seen, and I wrote about this in the book, I don't believe that there is a threshold where it actually is to your advantage to drink alcohol. Now, that being said, if you're going to have alcohol, it's actually quite clear which one is best for the gut. And the answer is red wine.

Red wine contains resveratrol. Resveratrol is a polyphenol, which actually has prebiotic effects, not in the same way that fiber does, but resveratrol acts on the microbiome and will initiate a change that's beneficial. The point is that you don't need to drink red wine. We hype up red wine for resveratrol, but that's not the only source of resveratrol. You can eat red grapes. we've not like literally peanuts peanuts peanuts have respiratory so so i don't think that you should necessarily like be hunting down red wine i let me say this let me just be honest i'm just

going to come clean on it make it easy having a glass of wine or a beer once in a while is really not a big deal having two on the weekend is not a big deal where i get nervous is the person who's made a habit of it oh this is my daily this is my daily drink That, to me, I don't like. And I will tell you that I've actually seen, Liz, I've actually seen women who drink with their husbands on a daily basis. And they develop cirrhosis off of two drinks a day. Interesting. Look, it is what it is.

It's not fair. Perhaps it's a body like mass thing that men are just bigger. But I see a clear-cut difference where a woman can actually become sick off of two drinks a day, whereas I've never met a guy. a guy having two drinks a day. I'm not saying it's good for them, but I've never met a guy actually developed cirrhosis off of two drinks a day. Typically for a guy, it's more on the order of like 8, 10, 12, which obviously is a radically different amount.

A lot. But a lot of people will say that red wine gives them acid reflux, which would feel like a sign that your gut isn't loving it. So what's the deal with acid reflux and why would somebody get that from, quote, unquote, the best choice alcohol? Yeah. So I think it's the acidity of the red wine because, I mean, look, an IPA is going to give you acid reflux too, a super hoppy beer. And so will orange juice and so will tomato sauce.

And so I think it's really the acidity that drives that more than anything. I think there's a vulnerability that's there in the person who develops acid reflux. Like they already have damage to the esophagus and so they feel it a lot more than other people do. And if you get acid reflux after drinking red wine, I mean, you know, to me it's pretty obvious. So drink less red wine. If somebody regularly has acid reflux, is that what should they be doing about that generally? So this is a good question because I get a lot of people that come into my office and, you know, the most prescribed medicines in the United States are anti-acid? are proton pump inhibitors.

Nexium, previsid, prilosec, protonics, okay? Those are literally the most prescribed medicines in the United States. That's interesting. And there have been these studies that have come out in recent years suggesting that they're potentially harmful. The reality is this. I mean, I'll spare you the 10-minute conversation about the details of the science. The reality is this.

In a perfect world, we don't want to have to rely on crowsy. long-term use of medication for anything. In a perfect world, that's what we want. But the problem is I'll have a lot of people who come in the office and they go, hey, doc, I've been hearing a lot of things about these PPIs. I want to get off of mine. And I'll look them in the eye and I'll go, look, are you ready to make changes? Because you can't live the lifestyle that you currently live and expect a different result.

The lifestyle that you live is part of the reason why you've developed the acid reflux. So the studies that have shown a benefit in terms of acid reflux, we have a study with a Mediterranean plant predominant diet that was as effective as medication. We have a study with a fiber supplement, believe it or not. And I'm convinced the reason why it worked in that study is because it was feeding the microbiome, and the microbiome is altering rotility of the intestine. And then we also have a study where they had people get rid of caffeine, no coffee, no tea, no soda, and they also got rid of alcohol, and they replaced it with water. Most of us don't. Well, that's tricky because it could be like, is the more water helping?

Is the fact that you're hydrating better helping or is the fact that you've eliminated all of these? Like, could you get the same results if you kept some of those in and just hydrated way better, especially because a few of those are inherently dehydrated? So you are like from my perspective, it's like this. Liz, if you're my patient and you come and you say, hey, Doc, I'm having this reflux and I want to try the hydration thing. I would say, try it. Try it. And if it works, good.

We won, right? If you can literally still have your cup of coffee and then just drink more water, okay, cool. We got what we wanted. But you haven't found that to be like commonly. Do you find that people need to eliminate all of those things to make a big dent in their reflux if they have it? Most of the time, if you have chronic acid reflux, you're not going to be able to make some small, subtle change. Most of the time, it requires you to be prepared for something radical. Interesting. Okay. We've talked a lot about the microbiome. So I just want to dive into the microbiome for a second.

First of all, can you explain as if you are talking to an alien what the microbiome is and why it's important, just in the most layman's, here's what you need to know terms. Before I do that, if I had a trophy, I would give it to you because I think it's really awesome that we're like 90 minutes into the podcast and now we're going to explain what the microbiome is. So it's really cool. All right. In layman's terms, we are not alone.

We are not alone. We are covered from the top of our head to the tip of our toes on all surfaces. with microscopic organisms. We call them microbes. You just can't see them. They're invisible to the naked eye, but they're there. They're as alive as you and I are.

Bacteria, fungi, archaea, potentially in some people, protozoa, which are parasites, viruses. Like we have all these. But they're concentrated dominantly in our gut, specifically the large, intestine, which we would also call the colon. That's where they live. They live in harmony and in

balance. There's good guys. There's bad guys. The good guys, you know, when your gut is working the way it's supposed to, the good guys outnumber the bad guys. And something that's kind of cool that I like to think about because it kind of like makes my brain expand and go crazy is that take a step back for a moment and think about like literally any ecosystem, any ecosystem. We could talk about the Amazon rainforest. We could talk about Central Park. We could talk about anything. The key to any ecosystem is biodiversity. Biodiversity is a very important word in the world that we live in in 2020. And when you lose biodiversity, like I don't like snakes and mosquitoes. But if you kill all the snakes and mosquitoes, you will create a hole in that ecosystem.

And you may not be able to fill that hole with the other species. And that could create problems and instability. And so, well, our gut, our microbiome literally is an ecosystem. It literally is, not like a kind of is. It actually is. And the key is biodiversity. So before, when I said diversity of plants, in that study, what they were measuring was the biodiversity of your microbiome.

We think that the more species that you have, the healthier that it is, because that's the way that it works. So the number one thing you can do for your microbiome is literally just eat as many different types of plant food as possible. I call it literally the golden rule. As I said before, I'm not into creating lists of like, hey, don't eat these 80 things. I have one rule. Let's keep it simple. No weighing your food, no macros, no counting calories. just diversity of plants.

And no matter what, you know, I think this is an important thing because I feel like you're the kind of person, I hope you don't mind me saying this, that attracts people of many different dietary philosophies. And that's a beautiful thing because I'll be honest with you, no matter who you are, no matter what diet you're into, the person who is willing to change their diet and the interest of their health is someone that I celebrate. I think it's wonderful. And no matter who you are,

you can incorporate this one simple idea, diversity of plants. And this is an incredibly powerful thing because in the study, diversity of plants was more important than veganism. Like, you could be vegan and eat a lot of junk food. And that's not a healthy diet. Or eat a lot of like the same thing every single day. Yeah, and that's not a healthy diet. And, you know, kale, like if you literally just ate kale all day long,

that would not be a healthy diet. And so when we do diversity, what we're getting is we're getting the advantages of all the different types of plants. And the key is this, that really what it boils down to is the connection between the fiber in each plant and our microbes in our colon. So I just described that the microbes are concentrated in your large intestine. When you consume fiber, which is found in plants, it wiggles its way through 20 feet of, intestine, unchanged, untouched, and it enters into the colon, and all of a sudden your microbes get into a feeding frenzy. And fiber doesn't just go in the mouth and come out the other end. Soluble fiber and resistant starch get chewed up and consumed by the microbes. They eat it,

they grow stronger, and then they reward you by releasing short chain fatty acids. which have healing effects throughout the entire body. But the key is this. The reason why diversity of plants is so important is every single plant has its own unique types of fiber. And these microbes, they're like us. We all have different dietary preferences. Specific microbes like specific plants.

If you have a black bean, there are certain microbes that will thrive because you just ate a black bean. And if you don't eat the black beans and you take them out of your diet, those same microbes will falter and grow weaker and eventually they will die. So the point is that it's not just black beans, it's not just kale. It's all the different types and the more the better. And in the study, in the American Gut Project, the number was 30 per week. 30 per week. And it's really, you know, I know that sounds very overwhelming. But let me tell you how easy this can become. Let me just give you an example. All right. So I alluded to the fact that I'm a 40-year-old guy who drives a

minivan. I have two kids at home. We eat like a normal family does. Some nights, no matter what you see on Instagram and how beautiful the food may look, some nights, it's spaghetti and tomato sauce. Okay. And so we will get organic whole wheat pasta tomato sauce. That's two plants. There's a lot a room for improvement. How easy is it to throw garlic, onions, mushrooms, zucchini, maybe some kale, maybe some spinach, throw that in your sauce. The house smells amazing. Everyone's exciting and salivating. You sit down to eat and then you throw some basil and some fresh parsley. Boom. On top. And now you went from two up to like eight, nine, ten, somewhere in that range without much effort.

It tastes better and your gut microbes are doing the river dance. That makes sense. You said there's good bacteria and bad bacteria. So the diversity of plant-based food feeds the good bacteria. What feeds the bad bacteria? So in chapter two of my book, I talk about how our 21st century life is overfed, undernourished, and hypermedicated. and there's a number of ways that we affect the bad bacteria.

And I think it's quite obvious that look at the standard American diet. 10% fruits, vegetables, whole grain, seeds, nuts, and my games, 10%. I was probably less than that for most of my life. I was probably 5%. 60% processed foods. 30% meat, dairy, and eggs. And a lot of that meat, dairy, and eggs coming from unhealthy sources, pumped up with antibiotics, pumped up with hormones. you don't look at that diet and see the picture of health.

So it's no surprise that it's killing our country, literally. And so when you think about what are the things, and I kind of lay it out in the book, but I lay out the processed foods, the refined grains, the sugars. And yes, in excess, saturated fat, be careful with coconut oil or coconut milk. So the number one thing for microbiome health is eating a diverse of foods. What's the number two and three things? All right. So eating a diversity of food, we fixate so much on diet, I guess to just close out diet, because I don't want to overemixate on it. To close out diet, you know, to me,

I view the microbiome as having this balance, right? So you can eat a diversity of foods and be 10% plant-based, you know, and it's hard for me to argue that that's a healthy diet. So you want to be a plant predominant diet and then, like you said before, sort of crowd out the stuff that can cause injury to the microbiome. But moving on from diet for a moment, I feel like there's so many opportunities that exist that have nothing to do with food. You know, think about our lifestyle today. Most of us are rushed. We're stressed. We're not sleeping.

We are using our phone, tablet, computer, TV late at night. And all of those things have an effect on our gut microbiome. So I feel like a couple of simple things that can be done. I feel like getting eight hours of sleep is important. Trying to attach that to our natural bio rhythm is important, meaning like don't go to bed at one in the morning and sleep to nine. Try to go to bed at 10 and sleep to six or more. I feel like the timing of our meals.

So like late night eating, I don't know if you ever heard this before. It's kind of weird. Like even for me, I just heard this in the last few years. Even for me, I find this weird. You can eat literally the exact same meal at two different times of day and have different metabolic effects. People who have diabetes can eat literally the exacts. And I'm sure there's people listening right now who are going to agree with me who have

diabetes. You can eat the exact same meal in the morning and in the eating. evening and you will spike your sugar in the evening and not spike it in the morning. So are you a fan of the like breakfast like a king, lunch like a prince and dinner like a pauper philosophy? I am a fan of making a stronger emphasis on lunch and that breakfast is from my perspective optional. So I personally most days don't have breakfast. But that's, you know, that's up to each person. I feel like lunch is where we need to fuel our body because that's when we're doing

the heavy lifting. And I feel like the excessive emphasis on dinner is unnecessary. But I think it's especially like you can have a lavish, you know, dinner that you're excited about. And it's different if you have it at 5 o'clock or 530 versus if you're having it at 9 o'clock at night. So I feel like moving that clock forward. You know, if you have dinner at 6 and if you want to have dessert, like I have a sweet tooth,

have your dessert and then make a rule water water only after dinner and if you can get three or four hours in of water fasting after dinner then when you wake up the next morning it's been 12 hours since you asked eight and that's actually incredibly healthy for your gut and it's really aligned with your circadian rhythm yeah i was going to ask your thoughts on intermittent fasting in general for gut health and it sounds like you're a fan is 12 hours would you say the optimal amount of daily fasting to do for gut health typically 13 is what is what you want to strive towards and i think one of the big things that i would really emphasize to people when it comes to this because it becomes so hot becomes so trendy one of the big things that i would emphasize is if you're like i see some people

who push this so hard 18 20 hour fast it's not necessary to push it that hard. And I feel like you cross a line with anything, you can exercise yourself to the point that exercise becomes inflammatory. And the same is true with fasting. There is a window where it's ideal. And then when you push it too hard, it's like, whoa, whoa, whoa, whoa. You don't need to push it that hard. Take it easy. And how about we focus on some of the other opportunities like sleep, like exercise, like meditation, like getting outdoors, like getting sun? Take advantage of some of those other opportunities as opposed to going, like it feels kind of like some people are all in on the fasting.

What about adding in more good bacteria via fermented foods and probiotic supplements? I am obsessed with fermented foods. I feel like fermented foods have been lost in our food culture. Every tradition, every culture from around the world has had fermented foods as a part of their celebrated tradition, every single one. And there's something unique about them in terms of the flavor that you can't get without them. And they, they, also unlock parts of our food that we wouldn't normally get access to. So it's more than just the bacteria or the living nature, which I think it's cool. I think it's cool that it's alive, but it's also that they release phytochemicals. They release new forms of fiber that we normally

wouldn't get. And I think a little bit of fermented food on a daily basis goes a long way. Can I ask you? I found this trick where if I eat like a spoonful of sauerkraut, when I have really bad sugar cravings, I have a really bad sweet tooth. They go away. And I don't know if it's just because the sort of pungent flavor or if there's something happening almost on a microbial level in my mouth that's making my sugar cravings go away. Would you have a supposition there?

So very, very well, very well recognized the fact that you've just described. If you read about the benefits of fermented foods, this is one of things people talk about. And it's not clearly known why that happens. but what is interesting, Liz, is you bring up a good point, which is that we think that our microbiome controls our food cravings. So when you change your diet, food that you wouldn't think you would start to love becomes increasingly appealing. And food that you, like you crave less sugar, I think, as your microbiome becomes more balanced

too, right. Yep, that's exactly right. That's cool. Okay. So what about supplements? probiotic supplement yeah so i to to um make a long story short i number one i feel like and i kind of said this earlier diet and lifestyle first prebiotic supplements second probiotics come third okay there's a problem with probiotics here's the problem liz you have a completely unique gut microbiome

there is no one on the planet with a gut microbiome exactly like you and when i give you a probiotic no matter which one I choose, I'm still giving you a generic formula. And I'm hoping that when that generic formula drops down into your unique gut microbiome, that it's going to create a biochemical magic. And the problem is you just don't know until you try. So I see patients who have benefits from probiotics. I don't mean to sound like I'm dismissing them as if they have no value. I think that the issue is that the probiotic hype is outpacing the science.

and many people believe that gut health is built on a foundation of probiotics, when in fact I personally, although I could get them for free, I don't even take them. Okay. Interesting. So it's like a try it, but first you would do a prebiotic. And also it sounds like you're a big fan of the magnesium supplements for that sort of cleansing and get rid of the constipation effect as well. Yeah.

And there's other supplements too, by the way. Like I'm not, so I'm not a, let me say that I'm not a believer in like 20 supplements at once. Like, I kind of feel like when you do too many things all at once, how do you know what anything is doing? So, but I feel like whether you are vegan or not, B12 is actually a very important thing to supplement. We have studies in omnivores where 40% of omnivores are either B12 deficient or very

close. I think that vitamin D, particularly in the wintertime when you're not outside, is an important to supplement. And I also am a believer in omega. a threes. You can do that through fish oil or you can do it through algae oil. Cool. Okay. So I'm going to do some speed round for you and they don't need to be like super speedy, but just like speedy-ish. Cambocha, good or bad and how much is too much? Good but a little overrated. You should only do about four ounces a day and dilute it out with water. But not and are you okay

with the carbonation in there. And are you okay with carbonation generally if you don't suffer from bloating? I don't have a problem with carbonation. There was one study that suggested the carbonated beverages can lead to weight gain. Yeah, I wrote about that for my muddy green. Did you? Yeah. So there is that.

I mean, I don't see advantages to carbonation, but gosh, I really love it. And since I love it so much, I'm just going to admit my bias. Fair, fair. Okay. It's a coffee. I feel the way about coffee, too. Yeah, so coffee was one of my speed round ones. Why don't you go ahead and do that?

Is it because there's a lot of talk about coffee being beneficial in diets, the blue zones. There's a lot of coffee consumption. Is it good or bad for your gut, would you say? Coffee, so this should not be the case. We should be embarrassed that this is the case. But believe it or not, coffee is the number one source of antioxidants in the American diet. Wow. And coffee contains polyphenols, which are prebiotic.

So it's good. It's good. And, you know, there's a reason why even decaffeinated coffee will make you poop. And that's that you're affecting your gut microbiome. Yeah, I know a lot of people who completely rely on their coffee to go every day. Is that, like, cool? I mean, I love coffee, so I don't have a problem with it. And I personally love to put my prebiotic supplement into my coffee.

And it works for me. Cool. Bone broth. Because a lot of people say that bone broth is one of the best things you can do to soothe leaky gut. Do you believe that? No, I don't. Okay.

So I don't have a study to say that it hurts you. I mean, we do have the, I guess I should say, we do have studies that suggest heavy metal toxicity as a potential because it weaches out of the bone itself. We don't have any studies, not even small studies, to say that it does anything for the gut. So it's hard for me to jump on board, you know, the hype train, which has left the station years ago. when I don't even have a small study to lean on. So, you know, I personally, let me say this, I will openly readily acknowledge that a warm beverage, which is electrolyte, rich, suits the gut, it soothes the tummy.

But is there something unique and special about the bone broth? Like, I understand the collagen theory, but that hasn't been ever shown in a study. Well, that was going to be my next one, collagen, yay or nay. and yeah just get into collagen. Don't be mad at me. I don't know how you feel about these things. So don't be mad at me if you are.

But there's no study with humans where they give them collagen and they show that there's a benefit to the gut microbiome. There are some studies with skin elasticity. All right. So there's some potential for benefit for the skin. We have to acknowledge that those studies for the skin were industry-funded studies. I feel like, you know, to me, we have so many things for gut health that are proven to work. Why would we waste $30, $40 a month on something that has never been proven to work?

That doesn't make sense to me. I like collagen as I almost use it as a one-ingredient protein powder when I get it from a reputable source. I like it because I don't like to have protein powders that have like 17 different things in them. and I like a single ingredient protein powder, so I use collagen as that. Colloidal silver, good or bad for your gut. Oh, gosh. So I have heard some conversation about colloidal silver. I personally have never prescribed it or used it, so it's hard for me to really comment on it very much.

Okay. Apple cider vinegar, good or bad for your gut. Vinegar in general is good for the gut. vinegar in general can improve certain parameters of metabolism, like, for example, insulin sensitivity can improve with vinegar. It's not necessarily that it's ACV. It could be other types of vinegar, too. So I sort of view ACV with the mother, like unpasteurized. I view it conceptually similar to kombucha. Okay. Yeah, I would too. I like it because unlike kombucha, I keep like big bottle of apple cider vinegar and then I'll make myself like a little tonic and it just

feels like something that's more readily available to have on hand. I also really like it when I feel like heavier in my body. It feels like it helps my body digest things. Is that true or no? Is it placebo? Well, I don't know if it's complete placebo. I mean, so here's what's interesting. So I mentioned earlier the benefits of short chain fatty acids, which are produced from fiber. They have healing effects in the colon. They have healing effects throughout the entire body. They go all the way up to the brain. They cross the blood brain barrier and have healing effects there.

Effect mood, memory, etc. Okay. Here's the key. Short chain fatty acids are, in fact, acids. They change the environment in the colon to become more acidic, which alters the balance of bacteria and is anti-inflammatory. So the point is that we think that adding vinegar, beverages. And I wouldn't recommend that people go out and go crazy on this kind of stuff.

Because the other thing to keep in mind is it can affect the enamel on your teeth. Yeah, I always rinse with water after. So, and don't, like, I don't really recommend doing it as shots. I always dilute it out. But that's where we think that the benefit of these vinegar-based beverages may be is that it may alter the balance of bacteria to a favorable type. Okay. What about food sensitivity tests? Are those worth the money in any way, shape, or form or no? I've seen some cases where they seem to be beneficial to people, but most of the time I don't opt for those. And the reason why is that, so keep in mind, people should know there's two main food sensitivity tests.

One is a blood test looking for antibodies. All right. So looking at the immune system. The second is a skin prick test where they will introduce a part of the food and see if you react to it. Both of those are looking at the immune system. All right. But what are we missing in this picture? We're missing the microbiome.

And the microbiome is critically important to our food sensitivities, and these two tests don't look at that. So the problem that we see with these tests is that many times, and people listening at home, if you've had these tests, I'd be curious to hear your experience. But many times people will say to me, hey, doc, like it said that I was, I had a sensitivity to this, but I don't have that. sensitivity like I feel totally fine when I eat that and so that's where they're just not helpful because if you don't feel a food sensitivity to it and then you go down a path of eliminating or restricting that food you haven't helped yourself that's interesting that makes sense um tea yeah or nay and is there like a great I know that herbal teas count as tisans um not teas but are there great kinds not great kinds we would just want to sort of drink beverages all day

that are good for our gut. What can we drink? Big time yay. Big time yay. Have unique prebiotic polyphenols different than coffee. I like coffee in the morning. And then my favorite type of tea is matcha green tea. The reason why is because matcha has this one unique polyphenol called EGCG. And you get 100 times more EGCG in matcha than you do in other types of green tea. It's very concentrated. So that's what I love. And herbals, I know you mentioned fennel is a big fan. Are you a fan of like ginger or any other sort of things in that world? I am a huge fan of all those things.

And the reason why is because I, so my book is called fiber-fueled, but really my book is a celebration of plants. And one of the things that I love about plants, which I do talk about in the book, are the phytochemicals. What are phyto, like, what is the phytochemical in the most layman's term? So phytochemicals are unique, like unique chemicals or compounds that you will find exclusively in plants. And examples that people have heard of are like beta carotene and resveratrol. And so, and these are produced by the plant. It's unique to the plants. Many times when you see the color, we talk about, okay, eat the rainbow.

Pretty pebbles. Many times, like fruity pebbles. All right. So each unique plant has its own, like the color is associated with specific phytochemicals. There are at least 8,000 phytochemicals in nature, at least, most of which we've never studied. But every time we study them, we start finding out that they have healing benefits in our body. So herbal teas, herbs and spices, they have phytochemicals. that's where the flavor comes from.

And that flavor has healing benefits. And so I universally agree and support. Thumbs up. What about cooked food versus raw food? Because people talk about raw food has enzymes that can help with digestion, but then a lot of gut diets will specifically have you avoid raw food because they require more digestive work and the cooking does some of that work. So what's your thought on the balance there?

The simple answer is both. If you have a damaged gut, you're going to struggle more with raw food. But we talked earlier about how each food has its own unique type of fiber. Like I talked about black beans, right? So what's interesting is they just did a study. And believe it or not, this was done by one of the guys who is supporting my book. His name is Justin Sonnenberg. They just did a study where they looked at different types of fiber, whether you cook or not cook, like raw versus cooked.

What they found is that as you cook the food, it actually transforms the fiber and will affect the gut microbes in a different way. So, little health hack, if you are cooking your food, let's pretend you're in the kitchen and you're chopping up some kale and you're going to saute or whatever, that kale. Nibble just a little bit of the raw kale. That way you are supporting the microbes that thrive on the raw and also supporting the microbes that thrive on the cooked. Unless you're making beans, in which case, just cook them because you don't want to eat the raw beans. Yes, we cover that. Is there anything else that people do that that's really bad for their gut health that we haven't talked about or that they think is good for their gut health that you're like, that's actually a huge fallacy and I'd like to correct it? I worry about the idea that if it hurts your gut, eliminate it.

That to me is the biggest misconception. all the studies where people eliminate foods from their diet, they end up with a less healthy gut. And I see these people in my clinic and they're like, you know, look, I felt better for like three weeks, but now I'm even worse than when I started. And they get on a progressively more restricted diet because they believe that this is what they're supposed to do to heal their gut, keep restricting. The next thing you know, all they're eating is like boiled chicken and potatoes and that's it. So that to me is my biggest concern is the idea. that elimination, like permanent elimination or like categorical restriction, is the solution.

It's not. It's finding your, it's reducing and finding your own limits, correct? Finding your own balance. Finding your own balance and, you know, basically accepting and recognizing the strengths and weaknesses of your own gut. Okay. And then this is, I'd like to kind of end on that note, but I have one final question, which is if you know you're going to go out and like have a bad gut day, like you're going to

go to the state fair and eat funnel case. where you're going to go to a crazy restaurant and just like you're going to have your birthday at Applebee's or something. What can you do to mitigate that damage? Do you have any thoughts on just like, I know I'm doing, I shouldn't be doing this, but I'm going to do it anyways. How can I help? All right.

So you could do the delayed release peppermint oil. Okay. Is one thing that you could do. You could take care of your gut before and after. You know, conceptually kind of what you're asking me is how do you, you, you know, How do you recover from a hangover in a way? Because I am convinced, and there's some studies to suggest this, that the hangover is actually due to the damage that you did to your gut

from binge drinking and excessive alcohol consumption. Oh, that's interesting. So to me, part of it is hydration. Part of it is introducing prebiotics. Part of it is giving your gut a break and letting it heal. So I feel like there's a place for fasting. I feel like there's a place for pre-botic fiber and hydration. And then ultimately when you do introduce food, ideally you're feeding your gut with something

that is diversity of plants, not necessarily like hyperintense, not necessarily like a big old salad, but you get that nice diversity of plants in the meal to try to get your gut reset and back to normal. Okay. That's doable. What about digestive enzymes? Like as a supplement, are you cool? would that be something I'd want to eat with my funnel cake or no? If you,

so if you take digestive enzymes and you find them to be beneficial, I really have no problem with them at all. The issue with digestive enzymes is that they haven't been studied because there's no standard formula. Everyone who creates a digestive enzyme supplement has their own formula. There are no studies explicitly with that. And I want people to understand that the digestive enzymes are plant-based. Okay, so that is not recrifice.

creating your bodily function. That is not supplementing the way that the human body works. What that is is that's effectively taking out digestive enzymes that exist in certain plants. Like, for example, you know, pineapples have bromuline, right? So you can take the bromuline out of the pineapple and put into a digestive enzyme, and it may help you to process and digest protein. But so the bottom line is if it makes you feel better, it's fine with me. I don't think it's going to hurt you.

If it doesn't make you feel better, then stop wasting your money. All right. Well, thank you so much for putting up with my barrage of questions. I feel like there was so much good information here. If people want to find you, where should they go? All right, guys. So you can find me on social media as the gut health MD. I'm on Instagram and on Facebook under that name as well.

You can come to my website, theplantfedgut.com. I have an email list. I have a COVID-19 guide. I have my research guide, which includes all the references and, you know, sort of my foundational teachings for for interpreting clinical research for you guys, which I talked about earlier. And I have a course coming this summer and I'm excited about. Oh my gosh.

That's so fun. Yeah. And that's very cool. So basically this is a deeper dive going beyond the book. It's going to be a seven-week course. I've beta tested it twice, have had amazing results, like amazing results, super exciting results. So, and it allows me to take on some of the things that I did not take on in the book that I really want to take on. And there just wasn't room with like, you know how it is list.

You have a linear theme that you need to tackle. And you can't get sidetracked into the other conversations. So these are some of the bigger conversations that I wasn't able to have in the book and that I really think can help people who. who are suffering with digestive issues. Awesome. Well, thank you so much for taking the time to chat with me today. I loved it. Thank you.

I hope you guys loved this episode with Dr. B. Remember that we're going to do a follow-up on Instagram. We're going to do a live together and answer all of your follow-up questions. So definitely follow at Liz Moody so you can stay tuned and not miss that. And then we're also doing a giveaway of a free session with Dr. B, $1,200 value over on my Instagram at Liz Moody. So watch that space for that as well. And my actually delicious detox is 50% off. So you can find that at Lismudy.com slash ebooks.

Check it out. And I hope that you guys love this episode. If you have asked the doctors that you want to see in the future, either whether it's like a specific topic that you want to hear about or a doctor that you would love me to have on, let me know. I would love to hear from you. And I hope you have a great rest of your day.

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