The Liz Moody Podcast - Gut Health Secrets: The Truth About Leaky Gut, Viral Infections, Chronic Disease & Acid Reflux with Dr. Robynne Chutkan

Episode Date: October 26, 2022

I’m so excited to welcome Dr. Robynne Chutkan to the podcast. Dr. Chutkan is a board-certified integrative gastroenterologist, microbiome expert, and author of four digestive health books: The Bloat Cure, The Microbiome Solution, Gutbliss, and most recently, The Antiviral Gut which comes out November 1st. She’s the founder of the Digestive Center for Wellness, an integrative gastroenterology practice dedicated to uncovering the root cause of GI disorders, and also serves as a faculty member at Georgetown University Hospital. On this episode, we talk about:  why chronic disease rates are on the rise  the one common thing that research shows makes you more likely to get viruses like COVID-19  the secret to decreasing the impact of painkillers like Tylenol and Ibuprofen on your gut health how to optimize your circadian rhythm to optimize digestion & eliminate acid reflux  exactly how to address acid reflux without using proton-pump inhibitors (PPIs) why you should stop buying fruit and veggie washes  how to optimize your gut to balance your hormones how your gut health impacts seasonal allergies (+ how to fix it) what leaky gut really means, from a scientific perspective  a doctor’s specific plan for healing leaky gut  why a lot of the gut health tests give the wrong diagnosis (what to watch out for, and what to do instead) a doctor’s exact plan for before, during, and after getting sick a doctor-approved soup recipe to make when you’re sick  why cancer rates are going up in young people + what to look out for  and so much more! We would LOVE to hear from you any thoughts, reactions, or takeaways you have as you’re listening, so definitely screenshot and tag me @lizmoody and Dr. Chutkan @gutbliss on Instagram.  To join the Healthier Together Podcast Club Facebook group, go to https://www.facebook.com/groups/healthiertogetherpodcast. This episode is sponsored by Olive and June. If you want to try Olive and June for yourself and have mani’s that last over a week, visit oliveandjune.com/HEALTHIER20 for 20% off your first Mani System!  This episode is sponsored by Cymbiotika. Get 15% off using code LIZ at cymbiotika.com.  This episode is sponsored by Ava Jane’s Kitchen Colima Sea Salt. Go to HealthierTogetherSalt.com to get your first bag of Colima Sea Salt for free.  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'm your host, Liz Moody, and I'm a best-selling author and long-time journalist. This podcast is all about helping you live your healthiest, happiest life, whether we're learning exactly how to set boundaries in our relationships, working through limiting beliefs holding us back from career success, or learning how to eat to increase our longevity. And yes, those are all real episodes. So if any of those topics sound good to you, scroll on back in the archives. Today, we are back to one of my favorite and most requested episode topics, gut health.

It's a topic we've talked about a lot on the Healthier Together podcast, mostly because there's just so much to discuss. But today, we are specifically digging into how our gut health is key to both avoiding and fighting off viral infections, among other illnesses and conditions. There are also so many myths out there about gut health, which is why I'm so excited to welcome Dr. Robin Chetkin to the podcast. Dr. Checkkin is a board-certified Integrative Gastroenterologist, microbiome expert, and author of four phenomenal books, including most recently the antiviral gut, which comes out on November 1st. She's the founder of the Digestive Center for Wellness and Integrative Gastroenterology practice dedicated to uncovering the root cause of GI disorders and also serves as a faculty member at Georgetown University Hospital.

In this episode, we talk about why chronic disease rates are on the rise. The one common thing that research shows makes you more likely to get viruses like COVID-19, the secret to decreasing the impact of painkillers like Tylenol and ibuprofen on your gut health, how to optimize your circadian rhythm for better digestion and to eliminate acid reflux, exactly how to address acid reflux without using proton pump inhibitors, why you should stop buying fruit and veggie washes. I have been saying this for years, and it was so nice to have Dr. Chet can back me up. How to optimize your gut to balance your hormones,

how your gut health impacts your seasonal allergies and how to fix it, what leaky gut really means from a scientific perspective and a doctor's specific plan for healing leaky gut. Why, a lot of gut health tests give the wrong diagnosis, including what to watch out for and exactly what to do instead. A doctor's exact plan for before, during, and after getting sick. A doctor-approved soup recipe to make when you're sick. I have written this one down. I'm going to make it the next time I'm sick.

For sure, I've already sent it to like 20 of my friends. why cancer rates are going up in young people plus what to look out for and so much more. As you can tell, this is a jam-packed episode and Dr. Chetkin and I would both love to hear your thoughts as you're listening to definitely screenshot and tag us both on Instagram. I am at Liz Moody and she is at Gut Bliss. There is so much research-backed and wide-ranging information in this episode that I haven't heard anyone talk about anywhere before. So please should a link to anyone you know who might be still taking regular antacids

or who might benefit from the plan that Dr. Chutkin shares for exactly what she does before, during, and after getting sick, sharing links to episodes is not only the best way to transform your friends and your family members' lives, but it's also the best way to support the podcast, and it is so appreciated. Okay, let's get right into this highly specific and nitty-gritty gut health episode with Dr. Robin Chutkin. Dr. Chutkin, thank you so much for taking the time to join me today. I am so excited. I think you have a very unique take on our microbiome and the power of it in the health of our body.

Well, thank you so much for having me. It's really thrilling to be on. I've followed your work for a long time from Mind Body Green Days. So it's great to reconnect here on the podcast. So can you just start us off by explaining in these simplest possible terms how the state of our gut health impacts the rest of our body? You know, it's this whole concept of health host mattering, Liz. And when I say the health of the host matters, you know, people are like, well, what do you mean by that? So I like to use the example of somebody having a heart attack.

If you are 85 years old and you are a smoker and you have obesity and hypertension and you're in poor health and you have a heart attack, you're probably going to have a worse outcome than a healthy 35-year-old who eats a great diet and is a runner and lean and all the rest. And we sort of understand that. But when it comes to viral illnesses, we don't really see it the same. same way, but the same rules apply. The health of the host is super important. And in fact, it may even be more important than the potency of the pathogen, because with a healthy host, with a healthy immune system, which of course comes from your gut, and we're going to be getting into that, you are able to handle the infection and ideally to not just survive, but thrive,

to not have a complicated course, to not have post-viral symptoms, et cetera. And those outcomes are not random. They are very much tied to what is going on in your digestive tract. And I just want to make this abundantly clear from the beginning because there has been so much controversy about this in recent years. How do you view the role of optimizing our microbiome or our terrain? How do you view that sitting alongside things like vaccines and avoiding exposure to pathogens? I'm so glad you mentioned that, Liz, because these two things are complementary. This is hand and glove. In no way does anything that I'm saying or anything in my book in any way suggests that you shouldn't be following public health guidelines,

including vaccination, et cetera, social distancing, quarantining, masking, whatever the public health recommendations are. So this is complementary to those things, not instead of those things. And I'm so glad that you mention that. Something that I always hear about is that we're over sanitizing everything and that's causing our microbiome to be completely destroyed and that's why we're more susceptible to disease. But then you picture in the old days, things were super unsanitary. People were like covered in dirt all of the time, but people were still dying of things like the flu and the plague and things like that. So how does that dynamic work? Liz, what we've seen is a pendulum has swung from, if we look globally, more people are currently dying from non-infectious chronic

diseases that are very much tied to what's going on in our microbiome. Now, there's still huge threats out there, right? We're all just sort of dealing with and still in really a global pandemic from an infectious organism from SARS-CoV-2. And viral and bacterial illnesses like cholera and tuberculosis kill millions of people every year. Regular influenza kills around 650,000 people globally. So these things are not inconsequential, but what we're seeing is that non-infectious chronic diseases like heart disease, like autoimmune diseases, like hypertension, diabetes, obesity, these things are also huge killers and responsible for a large amount of deaths worldwide. And you know, you mentioned that analogy of like, we think it's good to be dirty,

but when people were dirty, they were also sick. And that's absolutely true. But something really important happened right around the most recent industrial revolution. If we look at what happened, And maybe 1920s, 30s, turn of the century in the UK, for example, we see that droves of people left the farm for the factory as things became more industrialized. And what they also saw, using this example of the United Kingdom, is that there was a dramatic increase in autoimmune diseases, and particularly two, we look at things like hay fever, which is basically talking about asthma and eczema. They started seeing these skyrocketing rates of these two autoimmune conditions in British children.

And an epidemiologist at the Royal School of Tropical Medicine and Hygiene, Dr. Strawn, was tasked by the British government with trying to figure out why they were seeing these skyrocketing rates of autoimmune phenomena in British children. And he embarked on a 21-year study, 17,000 children, followed them from birth to adulthood. And he found two really startling factors, Liz, that were completely unexpected. The first was that kids from large families were somebody was always sick, a brother, a sister, a cousin always had the flu, a cough, a cold. Those kids who grew up in those households were much less likely to have autoimmune diseases later on. In some way, they were sort of inoculated by having all these other kids around them who were

sick and passing on illnesses. and their immune system was being trained not to overreact later on. So that was one finding that was sort of counterintuitive, but the second finding was even more unexpected. And it was that kids from wealthier households, where there was more general sanitation, more washing, more bathing, more cleanliness, had higher rates of autoimmune disease later in life. Now these days, wealth is not associated with cleanliness or sanitation,

and poverty is not associated with a lack of sex. sanitation necessarily, but back in those days and sort of post-industrial London, it was. And so it turned the whole idea of cleanliness being associated with health on its head and made us realize, gosh, maybe we are too clean. So when we talk about clean, we're not just talking about whether you bathed or not. We're talking about a more profound inner cleanliness in the sense of, are you never exposed to germs in your environment? Are you never sick?

Are you eating food that is created in a factory rather than coming out of the ground where it's rich with soil microbes? That's sort of clean versus dirty. Okay, so then how do we balance the idea that germ theory is real and we're supposed to be doing all of the things to avoid getting too much germ exposure, but also a certain amount of germ exposure appears to be beneficial? Liz, I'm so glad you mentioned germ theory because this idea, germ theory, that pasture, Louis Pasteure, popularized, which is that an organism, a bad organism gets into our body and makes us sick, is real and it's true and we see it every day. SARS-CoV-2, a virus gets into our body and it gives us COVID, and that is absolutely true.

But around the time that Pasteur was popularizing germ theory, another Frenchman, Antoine Bechamp, was popularizing his theory, terrain theory, which suggested basically that in a healthy host, a pathogen can get in and maybe make us a little sick, but not do too much damage because our soil is healthy. So terrain theory kind of pits the seed, the pathogen against the soil, which is the terrain. And when we talk about soil, we're really talking about, you know, our inner health, our immune system, our gut health, et cetera. And so again, it's this idea that you need both, right? So we wash our hands and we avoid people who are sick because of germ theory. We don't want to get exposed to those germs.

And that's really, really important. But terrain theory means that we pay attention to what we're doing as potential hosts. We eat a healthy diet. We exercise. We get sleep. We control our stress. We try to avoid medications that are potentially harmful to our immune system or gut health. And so both of these things, again, hand and glove, are really important.

Let's talk about some of the things that you mentioned in the book that help build that healthy terrain. There was a number of things that I hadn't really thought about in this capacity before, the first of which was stomach acid. Why is it so important for our microbiome and for our immune systems to have balanced stomach acid? I love that you led with stomach acid because it really was an article about stomach acid back in 2020 that led me to realize, I've got to write a book about this. And I'll tell you how that evolved. My husband is not in the medical field. He is in counterterrorism, counterintelligence, cybersecurity, completely separate field. And so I often use him to bounce things off of. So I'm like, okay, if he knows he's not a medical person, I mean,

he hangs out around me. So he hears me talk about this stuff a lot. But if he's not aware, that's a pretty good gauge that people aren't generally aware. So I said to him, in July 2020, a large population-based study came out looking at 54,000 people, and it asked a simple question. does the absence of stomach acid increase the risk for COVID? And the way they did that experiment is that looked at people taking proton pump inhibitors. You may know them as a little purple pill, but it's this class of acid blocking drugs that are really, really good at doing their job. They completely shut down the proton potassium ATP acid pump in your stomach, and they block your stomach acid.

And millions of people take these drugs for things like acid reflux. heartburn symptoms, et cetera. So they're really good at what they do, but the problem is that you need stomach acid to unravel viral protein when a virus gets in through your mouth and GI tract to render it inactive. And so what this study found in 54,000 people is that if you were taking a proton pump inhibitor, a type of acid blocker, once a day, you were about twice as likely to test positive for COVID. And if you were taking one of these drugs twice a day, you were about three to four times as likely to test positive. So I read this article, and I was surprised by how high the risk was, but I wasn't

surprised that there was an increased risk, because we've been seeing for decades that people taking acid blockers are more likely to come down with foodborne illnesses. They're more likely to come down with other viral illnesses on cruise ship outbreaks like norovirus and rotavirus, et cetera. They're more likely to have Clostridium difficile infections, that bacteria that can really start to reproduce when somebody has been on an antibiotic, and if you've been exposed to someone in the hospital, it's sort of a hospital-acquired infection. So we have seen for decades, clinically in the scientific literature, that a lack of stomach acid makes you more susceptible

to enteric infections, meaning infections that involve the GI tract. But I asked my husband, you know that being on an acid blocker increases your risk of getting COVID, right? And he looked at me, like, I had two heads. He was like, uh, I don't know that. He was like, how does that even work? So I explained that stomach acid basically kills a virus. It unravels the viral protein and inactivates a virus. And he was like, okay, yeah, I get that, but how would I know that? And then, Liz, I started asking some medical colleagues, and a couple of them didn't know. And then I asked some gastritorology colleagues. And I still got a couple blank looks. And so I said, okay, People really do not know this. And this is one of the body's most important first-line defenses

against viruses. So I've got to tell people about this. And there are a whole host of these other defenses, mucus, fever, sleep, all kinds of other things that are there to protect you that people may not be aware of and may not be taking advantage of in terms of either how can they optimize this or maybe even more importantly, how can they stop sabotaging it so that it can really do its job of protecting you. Is there anything else we're doing other than taking PPI that's having a really detrimental effect on our stomach acid? PPIs are really at the top of the list because they completely block the stomach acid. But there are certainly other pharmaceuticals that we take that mess up the gut. So if we think about things like antibiotics, that a typical

five to seven day course of antibiotics can remove up to a third of your gut bacteria. And these are not species that you can just easily replace with a probiotic and be like, okay, I took antibiotics, I've killed off a lot of my bacteria. Now I'm going to go to the store, take some probiotics, and I'm going to be whole. It unfortunately doesn't work that way. So antibiotics can really mess up the non-steroidal anti-inflammatory drugs that I was just talking about can affect the permeability of the gut lining, making it more permeable, therefore making it more accessible for viruses to penetrate through. And then we have immunosuppressive drugs like steroids and others that can sort of blanketly suppress the immune system so that you are less able to fight something like

a virus and clear it. So again, I am a huge fan of the pharmaceutical industry. I am very glad that we have these drugs available for when we need them, but I'm also a really strong advocate for more judicious use. And we know that many, if not, most of these drugs are overutilized. We know that particularly in people over 65, proton pump inhibitors, there's studies from the British literature that suggests that 80% of people over 65 who are on proton pump inhibitors or on them unnecessarily. We know with data from the CDC that in some studies as much as 30 to 50% of people being prescribed an antibiotic for things like upper respiratory tract infections don't meet the basic criteria. So a lot of the time, you're treating a viral infection

with an antibiotic, which of course has no efficacy against a virus and is actually in some ways making you more susceptible because it's killing off a lot of the healthy bacteria that are integral for fighting the virus. To the point of the ibuprofen or the NSAIDs, I've heard you say that if you're going to take it, like I take them when I have period cramps and I find it immensely helpful to take a 200 milligram dose. Is that right? That's absolutely right, Liz. And you're also right about them being immensely helpful. I mean, on the rare occasions, when I take them, I'm like, this is like magic.

So you can see why people can really rely on them, but you're absolutely right. If you can limit the dose to 200 milligrams or less, or if you can take it just sporadically, like if you're taking it for period pain, once a month, that helps. There are forms of ns that are less damaging to the gut lining. Those can also be helpful. And then, of course, ice, rest, physical therapy, massage, all of those things too. But for sure, if you can reduce the dose or the duration, that can go a long way. Which forms are less damaging to the gut? So a form of insides called Cox 2 inhibitors as opposed to Coxwan. So that would be cellocoxib, which some people know is Celebrex, and not suggesting that that has no side effects, but from a purely sort of gastroenterological point of view, Cellebrx is less damaging to the gut lining than the typical ibuprofen preparations. And can you just buy that at like a CVS? I believe that is prescription still. Bummer.

And then, of course, Tylenol, which. which we have to be careful there with your liver. So if you're taking Tylenol, you want to stay within the recommended dosage guidelines and maybe even less if you have underlying liver disease. If you have fatty liver, if you have cirrhosis of the liver, if you have any damage to the liver at all, the recommended amount for you might be even less. And lots of people find that acetaminophen, Tylenol, doesn't work as effectively in terms of anti-inflammatory effect, but you could even alternate, right?

So you're taking the ibuprofen for one dose, and then you're not. next dose might be acetaminophen, and you sort of bounce around like that to try and get the analgesia and the anti-inflammatory effect without doing a number on your GI tract. So get off PPIs if you're taking them without reason. But let's say somebody is listening and they have acid reflux. Can you share what they can do if they're trying to get off PPI's, but they don't just want to be uncomfortable all the time? Absolutely. So the first thing I want to say is do this with the help and direction of your health care practitioner, whoever's prescribing the or whoever's overseeing your care.

But I want to point out to people that acid reflux has nothing to do with overproduction of acid. Overproduction of acid is a very rare condition called Zollinger-Ellison syndrome that occurs in about one in a million people in the U.S. So that would be what? There are 350 people in the U.S. with Zollinger-Ellison syndrome. It's a rare syndrome.

But the vast majority of people who have acid reflux heartburn have something else entirely. what they have is inappropriate relaxation of the lower esophageal sphincter. And that's that little muscular structure that sits at the bottom of the esophagus, at the top of the stomach, is a sphincter between the esophagus and stomach, and the job of the lower esophageal sphincter is to squeeze tight once the food has traveled down the esophagus and gotten into the stomach. But what happens with a lot of people is that it opens inappropriately. And what causes it to open inappropriately?

Well, they're mechanical factors, and at the top of the list is just overfilling the stomach. So your stomach capacity is about the size of an open fist. It's not a ton of food. And many of us are sitting down and we're eating a lot more food than that in one sitting. So that's sort of overwhelming that sphincter, causing it to pop open, acid is coming up. When you eat is equally important, Liz, because the activity of the GI tract is actually tied to the light, dark cycle. So our GI tract is most active early in the day soon after the sun rises and then much less active once the sun sets. And unfortunately, that's when many of us are dumping in the most of our calories, a majority

of our calories and our stomachs are not as active. And so the food is sitting around for longer with more opportunity for that valve to pop open or we are eating late and then reclining so that we don't have the benefit of gravity like we do when we're upright for things to move down. So now we're flat and we're more likely to have acid reflux or we're doing things that open the sphincter chemically like alcohol, caffeine, smoking, even chocolate, unfortunately, all those things can open the sphincter. So the amount of fat we're eating in our food is another big one. Fat takes a lot longer for our GI tract to digest. So when we eat a meal with a high fat content, it slows down the emptying of the stomach,

again, leading to more opportunity for things to reflux up the recommendations from every single one of our GI societies is that we start with diet and lifestyle modifications. We start with eating the big meal earlier in the day, eating smaller meals, maybe small, more frequent instead of big meals. We put at least two to three hours between our last meal and when we're reclining. We try to stop smoking. We cut down on alcohol, caffeine. All of these things make a huge difference.

And I'll tell you, it's pretty rare when we really attack these things with people and really get them to implement these things that we can't get off the drugs. Now, some people have congenital abnormalities. Like that sphincter can be loose or they can have something called a haidal hernia, which means that some of the stomach actually comes up into the chest and they don't have as strong a barrier. So they're definitely anatomical things. There are some hormonal things, physiological things that can affect that sphincter. But for the vast majority of people, if they roll up their sleeves and really try with these

diet and lifestyle modifications, they can generally get to the point where maybe it's not that they have no reflux at all, but they can maybe get off the proton pump inhibitor and then take a drug like a histamine blocker, an H2 blocker. So that would be something like Pepsid or even an antacid that they can take on demand. With the PPI's, you have to take them every day. But with these other drugs, they could say, okay, I overdid it a little bit. I splurged, as my mother-in-law used to say, I oversported myself. And now I'm having heartburn and I need to take something.

But they don't have to take that every single day so that they still have sufficient levels of acid to attack those viruses when they're exposed. Would you recommend that even if you didn't have acid reflux that you try to eat when it's light outside to take advantage of how our circadian rhythm impacts our microbiome? A hundred percent. And what you'll find is that you just feel better. And I'll tell you, Liz, as somebody who is in that sort of perimenopausal time, it helps tremendously with hot flashes. And for any of you out there who are perimenopausal, menopausal, postmenopausal, and that's because digestion is a really active process and it takes a lot of blood supply. And so after you eat a big meal, there is what we call splankanick steel, which means a splankyx circulation that serves a GI tract actually kind of steals blood from some of the large muscles,

the quadriceps, the hamstrings, et cetera, to make sure that there is enough blood supply to the digestive tract for this very active process of digestion to happen. And some people can feel that vasodilation as it can worsen hot flashes. So that's one of the ways for me that I control things really well is I try to eat my large meal earlier in the day. That's when I'm busiest and hungriest and I need it the most. So, you know, somewhere between noon and three o'clock is sort of my sweet spot and a lighter dinner and, you know, you just sleep better. Are there other things we could do to kind of optimize our microbiome to help our hormone balance in general? Yeah, there are lots of things that you can do. And I always start with what are the things you're doing that you shouldn't

be doing? So what are the things? Are there medications you're taking? And I like to think of it as a sort of remove, replace, restore. So remove would be remove offending practices, medications, et cetera. That might be damaging your microbiome. So that would be, again, we talked about more judicious use of antibiotics and other drugs that can sort of mess up your microbiome, making sure that what you're taking you really need. And even though I mentioned antibiotics and acid blockers, there was a study that was published in the journal Nature a few years ago. And they looked at 41. different classes of medications. And they found that half of them had a pretty profound effect on the microbiome. And I give you an example, antidepressants like SSRIs, they have an effect on

the microbiome. There was a study a few years ago that looked at flukechine, an anti-anxiety, antidepressive agent that is marketed as Prozac. And they found that was associated with resistant E. coli in the GI tract. And so, you know, all of these drugs potentially have an impact. artificial sweeteners can create a lot of pathogenic bacteria in the gut. And so I don't limit it to just those medications. I think everything in your medicine cabinet, including over the counter, including supplements, you need to know exactly what you're treating, why you're taking this, what the benefit is, and what the risk. Because as it turns out many, many of these drugs, even the ones that we don't typically think of as being problematic to the microbiome, it turns out

that they are potentially damaging that, you know, very fragile ecosystem of gut bacteria. And again, that doesn't mean don't take these things. It just means take them judiciously, always know the reason behind why you're taking what you're taking. Exactly. And then the replace piece, which people, I think, sort of naturally think, oh, she means a probiotic. I actually mean exposure to soil microbes. Literally, we know that dip in your hands in soil every day for two weeks can change your microbiome. So I'm talking about thinking like, where is your food coming from? Is it grown in microbially rich soil or is it grown in a warehouse somewhere, you know, with no exposure to that good microbe rich soil? So think about

getting outside in nature. Think about getting a little bit dirty. Think about where your food comes from. And then there's an issue of, yes, prebiotics, probiotics, probiotics and postbiotics. And then the restore piece is really just what do you need to eat to create? To create a a rich diverse microbiome. And we have a lot of data on that. And of course, at the top of that food chain is fiber, plant fiber. We know from a really fantastic study that was done in 2018 by the American Gut Project, which is a nonprofit founded by Rob Knight and a couple other researchers to really look at the microbiome and the importance of the microbiome. And what that study found was that people who ate 30 or more different plants per week, different plant foods, had a much healthier,

more robust microbiome than those who ate 10 or less. And, you know, Liz, I have plenty of patients who'll tell me, oh, I'm a really good vegetable eater. I eat vegetables with every meal, but they're eating the same, you know, broccoli, carrots, and corn in heavy rotation. So it's not just the amount of servings of vegetables, but it is the variety of plant food. And I have a lot of fun seeing how many can I get to, right? If I'm having oatmeal in the morning, I'm using almond milk, one, the oats, two, pumpkin seeds three, walnuts four, raisins five, graded coconut six, blueberry seven. I mean, I just keep piling it on to see how robust and rich can I make this oatmeal. Same thing with a salad building. And you know, the incredible thing, Liz,

is it's not massive amounts of the stuff you need. We're talking about sprinkle a few pumpkin seeds in terms of being able to benefit from the incredible phytochemicals, the flavonoids and all the other things, the lignans in these foods. It makes a difference. The mattress that you sleep on is one of the highest exposures that you have. Like if it's off gassing, you're breathing that in for basically a third of your life. And most conventional mattresses are loaded with synthetic foams, flame retardants, microplastics, and more. Plus, if it's not comfy, you're going to be tossing and turning. You're going to be really hot and sleep is the foundation of health. It is so important. Because of all of this, if I were not going to invest in any other part of my house, no other things in my house, I would invest

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So we have two completely different sleep styles and we both wake up feeling really good, no aches and pains. CNN actually named the Birch mattress, the best mattress for side sleepers, and Wired named it the best organic mattress period. So there you go. Burch has options for every kind of sleeper in your household. They have three firmness layers. I like the Lux Natural, which is the medium one. And then parents, they even have a Birch kid's natural mattress. Birch ships right to your door. It sets up in minutes and it comes with a 120-night risk-free trial. So if it is not for you, they will pick it up for free. You have nothing to lose here. I want all of you to enjoy a deep, restful night sleep with a new mattress from Birch. Go to

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would from growing produce grown in the soil? Yeah, you know, Liz, it's a great and intriguing question, and I don't think I can answer that definitively, because if we look at hydroponic farming and stuff grown in water, we know that some of those foods are very nutrient and microbreach. Or if you think about fermentation on your own kitchen counter. You know, if I take some cabbage that I have downstairs and I chop it up and I put it in some salty water to brine it and I make sauerkraut and I try not to make it come up moldy like it often does when I make it as opposed to the wonderful Russian lady at the farmer's market who her sauerkraut tastes amazing. But what I'm doing in that process, just with a little salt water with that fermentation is I am producing lactobacillus

bacteria to really help enhance my microbiome. And I'm also providing the cabbage, which is a highly fibrous food, which is feeding my existing microbes. So a fermented product like that is a powerhouse combination of prebiotic, meaning the fiber and also probiotic, meaning the live bacteria. And that's not something that you're doing with soil. That's something you're doing with salt water. So I think you really have to look at the individual practice. Is it highly chlorinated water? What is it? of that and look at the quality of the food, not just from a nutrient point of view, but from a microbial point of view. And a lot of that has to do also with how far the food has traveled

because these microbes, they're pretty fragile. And so if you're eating food that came on a boat from someplace 3,000 miles away versus something that was grown 30 miles away. And that's why I'm such an advocate and a supporter of our local farmers because that food is, you know, whether it is organic or not, just based on how far it has come, it has microbial advantages. That's interesting. And then my second question about that is, like, how dirty are we ideally looking for? Because we have the fruit and vegetable washes. We get told that if we don't rinse our salad greens well, we can get various bugs and bacteria that can disrupt our gut microbiome and make us really sick. So is there a right amount of dirt to be exposing our stuff?

to? Liz, what's really interesting is almost all of those foodborne illnesses, big recalls that we see are from packaged salad greens. That's from the packaged salad greens that are being packaged in the factory that are getting contaminated. So it's very rare. I literally cannot remember. I've lived in D.C. for 25 years and I cannot remember an outbreak of, you know, E. coli lister, anything like that. That happened at the farmer's market. Not to say that it couldn't, right? So, it is, I mean, by all means, wash the stuff, but I do not think you need to use a vegetable wash or any of that. I think plain old water. And in the stuff that I grow, the little bit of stuff I grow hair, I mean, I know what's in my soil and I eat it without a lot of washing.

And whether you eat the dirt or not, and again, I'm not suggesting that you eat it, but it's good to see that there's dirt on it. You know, it's good to see that the carrots are all gnarly and funny and they have like little fingers growing out of them. They're not all a uniform 5.8 inches long and a uniform orange color because that's not how nature works. And in general, we can ditch the fruit and veggie washes and just be running it underwater in the sink. Absolutely. So you mentioned that when I asked you about hormones.

Is that sort of microbiome protocol going to help with all types of microbiome related things? Like would that help us if we're having seasonal allergies? Would that help us if we're having bad? breath or body odor, would that help us if we're trying to work on our immune systems? Is it sort of a generalized approach that because it's benefiting your microbiome benefits all things that your microbiome touches? When you think about the role of the microbiome in health and disease, you see, and you think even about where the GI tract is, it's right in the center of your abdomen. And then it's like spokes going out up to the brain and to the lungs and to the kidneys and

all the different parts of your body. And of course, 70 to 80 percent of the immune system is actually physically located in your GI tract. So there's a close connection. But at the same time, I don't want to oversell the microbiome. You know, if your kid is not behaving and there's not necessarily something wrong with their microbiome, or you could have a hormonal problem that is distinct from this. You know, you could have polycystic ovary syndrome or you could have primary ovarian failure or something. So I don't ever want to give people the impression that you just have to fix your microbiome and all will be well, because there are additional health problems, and problems are multifactorial. So if you look at autoimmune diseases, we know that disruptions to the microbiome are one of the

important environmental triggers, and we know that clinically, and we know it scientifically. So if we look at my neck of the woods in the GI world, it's a really important article published in the journal gut that showed that antibiotics early in life is a major risk factor for developing Crohn's disease later in life. but there are also genetic factors that can predispose you to Crohn's. They're dietary factors. We know that emulsifiers and food can be a trigger. We know that stressful events in people's lives can sometimes be triggers. So it's not always a straight line in terms of linking up the cause or the cure. It's not always just fix a microbiome. I've had tremendous success in a lot of my patients with inflammatory bowel disease,

getting their disease intermission, getting them off of steroids and other sort of immune modulating drugs and getting them feeling well with dietary modification using prescription probiotics. But those numbers are not 100%. We probably get that in about 75% of patients. And there's 25% where it just doesn't do the trick. And whether that's because there are other extenuating circumstances, there are other factors that are driving the inflammation, whether it's because the level of inflammation is so severe that it's not reversible or there's cellular damage at that level. Whatever the reasons are,

it's not always effective. But what I will say, Liz, is that it always makes sense to improve your health. And the beautiful thing about this stuff is that it's all like good, common sense stuff. You know, it's not like go out and take something toxic or do something that potentially is going to have a negative ripple effect in your body. We're talking about eating more plant fiber, maybe not super sanitizing our food in our body so much, getting out in nature, getting a little bit dirty. Like, that's all really good stuff. But let's say somebody came to you and they were like, I want to optimize my microbiome so that I can work on my allergies, or I want to optimize my microbiome so that I can work on my longevity, or I want to optimize my microbiome so that I can have better

immune health because we're going into cold and flu season. Would you, in general, give them the same protocol? Well, the first thing I would do, Liz, is I would tell them, I'm not an allergist, an immunologist, and I'm not a longevity expert. So tell me what your gut problem is, and we can get down to brass tacks. But in all seriousness, I'm very careful about staying in my zone. I am a gastroenterologist, and my area of expertise within gastroenterology is the microbiome and complex autoimmune diseases. So I can give somebody general advice about their allergies, and I could give them talking points to talk to their allergist, particularly if their allergist is very sort of solely pharmaceutically focused. But I would not be treating somebody's allergies

as a gastroenterologist. And I recently posted something about the connection between seasonal allergies and the gut, pointing out that 70 to 80 percent of your immune system, of these immune cells are actually physically located in the gut. They're right on the other side of the gut lining separated by a razor's edge, a millimeter, from the trillions of microbes on the other side of the gut lining. And there's constant interaction. The microbes are like air traffic control, telling the immune cells what to do. So obviously, what's going on in your immune system is going to be dependent on the health

of that population of microbes. And it's also going to be dependent on what is the health of the gut lining where that interaction is happening. Or there are multiple places where things are sort of broken down. is it an intact gut lining. And I'll give you a fascinating example of how that works. There's a species of bacteria in the gut, bacteroidatease, and when bacteriodydees that are in the gut lumen, so again, on the other side, from where the immune cells, immune cells are sort of inside the body because they're on the inside of the lining and the microbes are on the

outside floating around in the lumen and attached in that mucosa layer, but they're not on the inside of the body in the sense that what's in the GI tract is sort of outside of your body. So bacteriodyides are monitoring what's going on, right? Because your immune system and your gut is in contact with literally trillions of organisms and it has to figure out what is friend, what is foe, what it should react to, what it should ignore. When bacteriitis sense, for example, viruses that are a threat and the bacteriitis are, again, in the gut lining, it triggers, releases something called interferons. And they're called interferons because they interfere with the attachment. of these viruses. So it triggers a release of interferon, which then triggers this immune cascade of cytokines and other compounds that can fight the virus. So you can start to really see that if your complement of bacteriitis are not sufficient, if there is a real imbalance and deficit in your microbiome, that triggering may not happen. And that signaling, that immune signaling can be disrupted. And so this is why it's so important to think about the health of the microbiome.

But I was pointing that out that there is this direct connection because, again, if the gut lining is not healthy or the microbiome is not healthy, there can be disruption with the signaling. And what can happen, Liz, is you can have an overblown response, right? And we see when we examine people with seasonal allergies, just like when we examine people with autoimmune diseases, we typically will see some changes in the microbiased. bio. And that's true for a lot of diseases. It's true for diseases like Parkinson's disease. It's true for certain types of heart disease. It's true for autoimmune diseases. It's true for people of seasonal allergies. But again, we can't always draw that direct line for treatment because there are other

reasons that people also have allergies. There are other factors, right? Can you talk to me about leaky gut for a sec? I feel like it's one of those words that's just thrown around so casually in the wellness world. And some people are like, it's total bullshit. And other people are like, no, it's real. So I would love your professional take on what's happening there. Absolutely. I'm happy to step in here. Leaky gut really refers to a mechanism rather than a disease entity onto itself. And so when we talk about leaky gut, we're talking about an increase in intestinal permeability. Because the lining of the GI tract, now that's that millimeter thin barrier essentially between. the microbes on one side and the immune cells and everything else that's inside your body. And like a

fishing net, it's permeable. It has little holes in it because it is bidirectional. So moving through the net, getting into the bloodstream are the nutrients as a food is broken down into the constituent nutrients, passes through that net. And the gut microbes are very instrumental in helping with that passage, deciding what goes through what doesn't, helping to break down the food. So nutrients go in through the mesh, through the little fine holes, and then cells excrete waste out, right? When the cells are busy doing their business, they have waste matter, just like we do. And that cellular debris gets excreted out through the net from the cells in the body into the lumen of the GI tract, where it, you know, contributes to the products of digestion and

fecal waste and it gets transported out. So it's all very efficient. But what happens is if that net starts to break down. So imagine a fishing now with big holes, right? So now things are getting through, passing through in both ways that shouldn't. And one of the things that can pass through is food particles that have not been properly broken down. So poorly digested food. And when that gets through, that can trigger an immune response. And that's why there's a strong association with increased intestinal permeability and food sensitivities. If toxins and things get through that normally should be kept in the gut lumen and excreted,

they can get into the bloodstream, travel to distant organs, and trigger a wide variety of different responses, whether it's joint pain or a rash or different things like that. But to your point, Liz, I think there's a real tendency to attribute everything mechanistically to this. And it's virtually impossible to prove that it is an increase in intestinal permeability. So I do some testing in my office with patients where they'll drink the solution and there's a small sugar and a large sugar. And then we measure by collecting urine how much of the large sugar is being excreted in the urine, suggesting that it's passing through the net, right, inappropriately. So it's not just the amount. It's really the ratio of the big to the large molecule.

And it's a fairly straightforward test. But I'll tell you, so many people will have a positive result. And we know that, for example, intense exercise can increase your intestinal permeability. So if I go run 10 miles super fast, which I can run 10 miles, but not super fast, I'm a slow distance runner. But let's say I go running for three hours and you were to measure my intestinal permeability before and after, you might find a significant increase. And it would typically go back down to normal.

But there are a lot of other things. You know, if somebody's taking an inset, it could temporarily go up. So it doesn't mean that because an increase intestinal permeability has been associated with food sensitivities with non-specific symptoms like joint pain, headache, fatigue, et cetera, it doesn't mean we can say that's what's causing your symptoms, right? You could have a headache because you're dehydrated. You could have joint pain because you overdid it at the gym or you're sitting for nine hours a day. So I think we have to really be careful about how we draw these straight lines and we oversimplify

what's going on in our bodies. And really, I think the best advice is we should optimize what we can, for sure, because these things are all connected. And the gut, I mean, not to brag that the GI tract is the most important organ, there's no most important organ. They're all important. The interconnectedness of it is so important. And I really want people to think about, you know, we talked about medications, but food too, you know, when you're on your fifth cocktail, I want you to think about the fact that alcohol is bactericidal. It kills off healthy bacteria. That's why when you go to get your blood drawn, they use a little alcohol swab and clean the skin. They're killing off the microbes, right? So I want you to think about how much alcohol you're consuming, how much refined sugar

you're consuming, how many ensigns you're taking, all of these things, right, and optimize. And it doesn't mean you might never have a sip of alcohol or never take a motron, but think about the ripple effect that these things have and how you can optimize everything to make sure that you're sort of protecting these defenses and not sabotaging them. Does that test that you do have a name that somebody could ask their gastroenterologist for? Yeah, it's an intestinal permeability test, but I'll tell you, for years, I never did it. And the reason why, Liz, is because it was sort of a coin toss. Because it's like, is it permeable at the moment or is it permeable over time?

And it's affected by so many other things. So it is not a test that we can really hang our hat on. And unfortunately, a lot of the tests that we use in this sort of groovy world of integrative gastroenterology are not super reliable. So another one is a test that we use for SIBO for small intestinal bacterial level growth. And that's a breath test. But if I take 100 random people and do a SIBO test on them, I'm going to see a positive test in somewhere between 11 to 30 percent based on what study you look at. So what's really important

is a good clinical history and somebody who can really understand these processes and roll their sleeves up and try and figure out what might be going on and not necessarily just a long list of tests and a big shopping bag full of supplements because I find that is rarely the answer. And just a last super quick question about this because I don't want to. to leave anybody hanging. But if you've decided that somebody does have leaky gut in a chronic way, what kind of protocol do you use with them? So the first thing that I do again is I take a very careful look at their medicine cabinet, prescription over-the-counter supplements, everything, teas, potions, powders, tinctures, everything that they're doing to make sure that there's

nothing in there that could be damaging to the gut lining. And that will include also things like how much alcohol they're drinking, what does their diet look like. I take a really careful look at that. I also remind them that the indigestible plant fiber isn't just for the gut bacteria. Plant fiber is fermented by gut bacteria to short-chain fatty acids. And short-chain fatty acids like butyrate and propionate are also essential for maintaining a healthy gut lining. So I really try and get them to ramp up the production of short-chain fatty acids by changing their diet. That's critical for a healthy gut lining. And what does that mean specifically? Like, what are we adding to our diet for our short chain fatty acids? Could you give us like one or two short chain fatty acid

superfoods? It could be oatmeal. It could be kale. It could be salary. It could be beans, legumes, all of those fibrous foods. So just high fiber and it's insoluble fiber. Is that right? It's really a combination. So when we think about one of the bacteria that really is one of the biggest produces of short chain fatty acids is a bacteria called fecalibacterium prosnitia. F. Presnit CI, and it's very correlated with the levels of short chain fatty acids. And if we were to drill down a little deeper, Liz, we would be looking at foods that are high in a type of fiber called inulin. And so that would be things like artichokes, asparagus, garlic leaks, onions, all that stringy dense fiber. That's all really good. But there are very few fibers plants that are not good.

I like those foods. Like garlic leaks, onions, figure in. in pretty much everything I cook, except if I'm baking. Does it matter if they're cooked or raw? Are they equally good for your microbiome? They're just as good. Okay. So we're adding in these things for our short chain fatty acids. What else are we doing if we're trying to deal with a leaky gut?

So we talked about medications you have to be careful about. We talked about the diet. And then there is some data for glutamine and zinc supplements, but it's not strong. And usually the way I handle it with patients, is if somebody feels really strongly, like they're like, I really want to take a supplement. I will recommend that combination of glutamine and zinc. But again, the data is not super strong. But if you're taking it at the recommended dosages, there's not a huge downside for taking those two things. So those are pretty reasonable to recommend. And what I find is it is so often it is that somebody is doing something that is causing the damage.

You know, the gut lining isn't just deteriorating on its own. Maybe they're taking a cough medicine and they didn't realize it had ibuprofen in it and they're taking that frequently or they are drinking two drinks a day. And while two drinks a day in one person might be okay, two drinks a day in somebody who has had severe infections, taking a lot of antibiotics, maybe been on an acid blocker and also has taken a lot of inseds is two drinks too many. So the background noise is so important. And it's difficult to just sort of prescriptively say, right?

So if we look at something like alcohol, we know from a lot of the large population-based British studies that when we're talking about reproductive cancer, so ovarian and endometrial and even breast cancer, we know that the magic number seems to be you've got to stay south of six drinks per week. So less than one a day. But when we think about the GI tract and we think about fatty liver, for example, and so on, So much of it depends on what else is going on with your terrain. What other medications have you taken?

What kind of diet do you eat? What does your exercise look like? Your stress, et cetera. So I think it's really important to get a very individualized sense of what else. Because while one person might have leaky gut and might get away with still having a little bit of alcohol, for somebody else, it might be like, this is going to be that nail in the coffin. And for you, abstinence is really the way to go to help your gut line. regenerate. If you have headaches, allergies, brain fog, skin irritation, or you've been dealing

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For a limited time, get 15% off with code Lillard. at one skin.co slash Liz. Again, that's 15% off at oneskin.com with code Liz. I would love for you to talk me through like a little timeline of when you get sick. So I would love to hear personally what you do when you're healthy to avoid getting sick, maybe like one or two things that you haven't mentioned yet. And then I would love to know if you're sick. And I'm talking about things that circulate like the flu or the cold or something like that.

if you're sick, is there anything special that you add in? And then what do you do after being sick to make sure that your microbiome is fully recovered? I'll tell you exactly what I do. And I'll use two real life examples. So when I had COVID this January, my family, we all went down to Jamaica over the winter break. And we came back with COVID, which I'm quite convinced we got on the plane going down on Christmas Day, which was a pat plane. Everybody held a drink in their hand and had their mask down the whole time, everybody else on the plane, not us. And people were coughing and every seat was full and I'm quite sure we got it going down six days earlier. But when we came back, really interesting thing, Liz, is one of the factors that we have found contribute to differences

and outcome after COVID is something called the outdoor air factor, the OAF. And the OAF is defined as the germicidal constituent in open air. So what does that mean? It's something. thing floating around in the ether outside that can be toxic to viruses and to certain bacterial illnesses too. And we know about this from 100 years ago, the Spanish flu 1914 to 1918, people who recovered outside and cots had a much lower mortality. And we know about a lot of this from the military statistics that the officers who were put inside in beds inside the hospital versus the enlisted man who were often just put on cots outside. In some of these studies, we saw a of 40% mortality for in the hospital versus 13% mortality outside on the cot. So for the last couple

years, I've been knee deep in all of these statistics and articles and reading up on all this stuff. So I told my husband last summer, if I get COVID, I want put me outside, like make up a little cot for me on the back deck and just bring the food out to me and I'll be fine. And just to be really, really, really clear because I think we've all internalized that transmission goes down when you're outside because the virus kind of can't make its way through the air, it's spreading out in the air, all of those things. But you're saying not only does transmission decrease for viruses when you're outside, but actually if you have already acquired a virus and you go outside, it helps you heal faster. That is absolutely correct. So I'm glad you made that distinction.

But here's a problem, Liz, I got COVID right after New Year's like a day before a major snowstorm here in Washington, D.C. But every night, once, you know, it got dark and people weren't around and there was tons of snow out, I would double mask and put on my coat and walk around the neighborhood for as much as I could. And I really realized how important it was to do that after the second day we'd been traveling. I'd been lying on my back. And I started to feel a little chest pain and feel a little uncomfortable taking a deep breath. And I realized if I keep lying on my back like this and taking shallow breaths, I'm going to get some alveolar collapse. Some of the parts of my lungs are not going to be well aerated, not well inflated. And I'm going to start to get

pooling of bacteria, and I'm going to be at risk for a secondary bacterial infection, a bacterial pneumonia. So I hopped up out of bed, not feeling well, bundled up, masked up, and I started walking. And again, you've got to do what you're able to do based on your baseline. So I'm a runner, slow, but I run long distances. So for me, walking two or three miles, slow pace is fine. I'm not suggesting that if you're not exercising a lot, you go and do all of this and make yourself really fatigued and short of breath. But even if you just sit outside, you're getting that OAF, right? Absolutely. And actually, being upright and taking deep breaths is really important for keeping those lungs expanded. So not only was I walking as much as I could getting the OAF, I was also using

something called an incentive spirometer. And you might know that as the little breathing apparatus they give you, if you've ever had surgery, been in the hospital, they give you that, they have you do these usually 10 breaths. And it's really the inhalation or inspiration that they're having you do. It's not the breathing out. It's a breathing in because it's a breathing in that inflates the lungs. When you breathe out, you deflate the lungs. But sometimes when you think about deep breaths, we're focused more on the exhale. But it's really the inhale. So this little incentive spirometer that I literally bought for $10 on Amazon. And I had all this stuff. In my house, I had the O2SAT monitor, I had the incentive spirometer, I had all of this stuff.

So I was using this and making sure that I was doing 10 breaths every couple hours. And I'll tell you, Liz, it really helped my running later on. And it helped my yoga practice because I was like, wow, I'm really breathing deeply. And it gives you a little setting, right? And it has like good, better best. So of course, I got competitive with myself. And I was like, I've got to get it all the way to the top level and do these deep breaths. So I did that.

And then I was making what I call my immunity soup, this leak soup. There's a wonderful lady who helps take care of my parents. And she is also from Jamaica. And she made the soup and dropped it off when I had COVID. And it was delicious. And it felt so good. And I said, what is in the soup? So here's what is in the soup.

And even if you have never cooked anything, if you've never even boiled water, you can make the soup. So you get some leaks, ideally ones that come with a little dirt on them so that you know they were not. grown in the warehouse, but they were grown in the ground. Chop up leeks, chop up garlic, onion, and I use a little skellion, green onion. So you want to saute all of that in a little olive oil. And I usually do the leaks first because they're sort of tougher. And then when they're all really soft, you put them in the blender. I put them in my Vitamix with a little bit of broth. I use veggie broth, but you can use chicken broth, and you blend it up. Now, I have since added to that, I will add in a little coconut milk, a little curry powder, a little turmeric. I put in a very

hot pepper called Scotch bonnet pepper, it's similar to habanera pepper because I like some kick. So I've made all kinds of different permutations of it. But this stuff is incredible. And we were just talking about inulin. So we were talking about the leaks and the onion and the garlic. And you can throw spring onions in there too. So you were getting like this infusion of inulin. and the hot liquids a lot of people find feel good going down also when you have a viral illness. So I was doing that, drinking that soup. I didn't have much of an appetite. I was staying hydrated. It's essential. Remember that we have more ACE2 receptors for COVID for SARS-Co2 in our GI tract than we have in our lungs. And the GI tract is a common binding site. And that's why GI symptoms

are so common with this. And because we're trying to sort of flush the stuff out, it's important. for us to stay well hydrated. That is literally for a lot of these infections that get in through the gut, they are excreted in the stool. I mean, you can check for viral shedding in the stool. So we know we're eliminating the virus through the stool. And so you have to stay well hydrated. And my rule of thumb that I recommend for people is minimum, half, whatever your body weight is in pounds, in ounces of water. So if you weigh 140 pounds, that's 70 ounces of water. If you weigh 150, that's 75 ounces as a minimum. And that doesn't include tea or coffee or anything else you're drinking, just plain water. And, you know, it's incredible, Liz, what a difference that makes,

not just for helping to eliminate through the GI tract, but for the headache, for the fever, for everything else. And a virus like polia virus replicates 250 times faster at normal body temperature compared to when you have a fever. So fever is a body's way of slowing down and even halting viral replication. So again, you got to think twice before you reach for the Tylenol or the Motrin. But there are other ways to be comfortable. And one of those ways is to drink a lot of water, room temperature water, cool water, et cetera. So I was doing my walking, using the incentive sprometer, drinking my leek soup, drinking tons and tons of water. And all of those things were really helpful. And of course, getting sleep. And they really helped. And then I told you I'd give you another example.

The other example is in May of this year, I was gallivanting down on the marsh in South Carolina, where my husband's from beautiful Beaufort, South Carolina. And, you know, for whatever inexplicable reason, I thought that a strapless dress and flip-flops were the appropriate attire to be exploring on the marsh. And both my husband and I got bitten by these little insects called chiggers. Are you familiar with chiggers, Liz? I am. They're awful. They're terrible, right? So this was the weekend of like May 22nd, 23rd. Now, my husband has had chiggers a lot in his life because he grew up down there. And so we both got him in the typical

areas that are sort of damp in the groin and across abdomen, you know, under my breast. So almost along the margins of where your underwear would be, right? But his three weeks later were better. And mine, four months later, Liz, were still a problem to the point where not only were they not getting better. They were getting worse. I had to have a biopsyed. All my doctor friends, it's like, that's the one perk of being a doctor, right? Like you have the dermatology friend, the pathologist. I mean, it's like Labor Day. My dermatology friend is leaving her home and kids to come in a biopsy me. My pathology friend is like doing a rush on it. So when they looked at this, they were like, this is just for some reason, like a prolonged hypersensitivity response.

And it probably turns out that you're allergic to these things. Your immune system has never seen them. So a little bit of immunology 101, you have the innate immune system that you're born with that responds quickly, but non-specifically. So like you get a cut, it just starts responding to protect you from any bacteria that might be coming in. And then you have the acquired immune system. And that develops over time. And that part of the immune system keeps a memory, like literally a ledger, a little

notebook of every pathogen you're exposed to so that when you're exposed to it again, it can mount an immune response. And so this is the whole basis for vaccines, right? You expose a person to a little bit of the vaccine, and then it makes memory cells, and then it can mount a response when you get exposed to it. So I had never had chiggers, unlike my husband and my immune system just sort of went bonkers. But when I kept thinking, because I always want to know why, I'm like, I don't want to take this prednisone or any of this stuff. Like, I spend my whole career getting people off this stuff. I've got to be really bad off before I'm taking this. And I'm happy to report that I'm on the mend and I did not need to take that. But I was like, why would this have

happened to me? I mean, I have a couple common autoimmune diseases. I have a little bit of eczema, reynodes phenomena, but nothing that's active. And then I thought about what had happened earlier in the year. I'd had COVID in January. I had a snowboarding accident in February that led to a concussion, a cracked tooth, a fractured root, an emergency root canal that went wrong. And and just couldn't be done, and an emergency tooth extraction where the tooth shattered. And with all that inflammation and infection, I was on round-the-clock motrin, antibiotics, all of this stuff that I never take. And I thought about, you know, what was a background noise, right? Why? Like, we know what this is. This is a prolonged hypersensitivity response to an

orthopod to an insect. That's my diagnosis. But why? Why was my immune system going so, hey, wire. And then I also thought about what had been going on before that. I'd been going to bed really late finishing up my book. I had so much stuff going on. And again, that combination of lots of stress, very little sleep, tons of non-striidal anti-inflammatory drugs, antibiotics, and, you know, again, like an explosion in my mouth, the concussion, all of this. And I was able to say, you know, I am not surprised. And it's a very long answer to a question, but what did I do? And again, I'm not suggesting that if somebody is having an immune response, they may need a steroid. That's not necessarily the wrong thing to do, right, depending on the particular problem they're having. For me,

it wasn't the right solution. I did end up getting a little intralesional steroid injection because some of these things were getting really big. So for a couple of the big ones, my guardian angel dermatology friend, Dr. Paula Borrelli, did inject a few, and that helped tremendously. But what really helped Liz was me figuring out, okay, how am I going to calm my system down? I've got to be really tight with a food, no alcohol, 100% plant-based. I've got to get to bed at night. I've got to get back meditating. I've got to restore a sense of grace and calm to my system and remind myself, I mean, literally,

I was saying these little aphorisms every day, this two shall pass, this two shall pass, this is going to get better. And I know it sounds, you know, woo-woo. And again, like, I was using antihistamines to help with the pain and the itching. And I did get the lesions injected. But I realized there was still a lot that I could do to improve my terrain. And in this particular instance, it was a lot of mind-body stuff with the stress and the sleep. And, you know, obviously I wasn't taking those pharmaceuticals anymore. But I really think that that is why, my system went a little nuts. It's so interesting to even have the awareness, I think for a lot of people, myself, certainly, that these things can add up in this way. Like, I don't think I would have

correlated a root canal or COVID months and months and months prior with this type of reaction. And I think it's actually really helpful to even just start to think of things synergistically instead of completely separate. Absolutely. I mean, to always ask why, right? And again, you can't always draw that straight line, but to realize, like, what's going on with your terrain? You know, what's happening with your soil? And can you make your soil a little more fertile, a little richer? And one of the just amazing things that I love right now is people like you who are bringing this information to listeners. And unfortunately, you're not getting this information from your doctor a lot of the time. I mean, they bring other important information.

And the conventional side of things is really important, right? for sure. But it's really important for people also to understand these contexts and the nuances. And I just think we live in a tremendous time right now where there are so many people with fantastic podcasts like healthier together who can help educate and inform listeners so that we can all be healthier together. Absolutely. I wholeheartedly agree with that, obviously. Okay, so this is a little bit of a left turn. But there was some research recently about how young people are having unprecedented rates of colorectal cancer. Have you seen or heard about that? Absolutely. That is absolutely true. And when we think about why that might be happening, and again, multiple factors,

right? And is there a genetic predisposition, et cetera? But you're probably also aware, Liz, of that article about the link between ultra-processed foods and colorectal cancer. And the link was most prominent in men. I believe it was a 29% increase in likelihood of colon cancer and men who were eating large amounts of ultra-processed food and then 20% in those who were eating not as much ultra-processed food. But there is the issue of the immune system because the immune system doesn't just protect us against infection. Cancer surveillance is a huge part of the immune system. So when we think about an overactive immune system, we think about autoimmune diseases and allergic reactions of the kind I had to the chiggers. But when we think about an underactive immune

system, we think about inability to clear an infection, whether that's viral, bacterial, fungal, protozoal, et cetera. And on the other hand, still talking about an underactive immune system, we think about cancer surveillance and cancer surveillance being off, which is why drugs that immunosuppress us have those two risk factors, increased risk of infection and increased risk of cancer. And so you think about, you know, what might be going on with the immune system based on what's on in the gut because of that hand-and-glove relationship. And then you look at the data on things like emulsifiers in food and other components, other ingredients in ultra-processed foods and the rates of colorectal cancer. So again, I don't think there's any one answer, but I do believe

that there are things happening. I mean, I don't know anybody who doesn't have an autoimmune disease almost. You know, it's like everybody has something. And then you think about the quick, convenient food that people are eating all the time. And And I think there's got to be something to those two factors. If a young person is listening to that or really any person who's like, that's really scary, I don't want to get colorectal cancer, is there anything that we haven't talked about yet that you would recommend they either avoid or start doing? Like, should we be starting to get colon cancer screening colonoscopies earlier in our life?

Or how should we take that news in a proactive sense? Well, the first thing I want people to realize is that colonoscopy does save lives. Right? Colonoscopy can diagnose and remove a polyp, which is a pre-malignant lesion. And so if that polyp is found and removed, it means that that can never turn into cancer. And there's usually about a four to 10-year lag from when a polyp develops to when it turns into cancer. So colonoscopy is not just a diagnostic tool. It is an important therapeutic tool. And the new age for screening is 45. But to your point, Liz, we're seeing a growing population of people under 45. who may never even have reached the age for screening, who have their colon cancer.

One of my really close friends, who's also a gastroenterologist, developed colon cancer a couple years out of her GI fellowship. She was in our 30s. So the other important part of that is pay attention to your symptoms. She had had blood in her stool that she just thought, oh, it's hemorrhoids, it's not a big deal. Pay attention to those symptoms. And even though, you know, I'm a woo-woo food and stress and sleep and all these things are important. I am going to be the first one to tell you, if you have blood in your stool, get to a

gastroenterologist, get evaluated, take it seriously. So not just blood in the stool, but unexplained abdominal pain or discomfort, unexplained weight loss, a change in your bowel habits. These are things that be related to diet and lifestyle, but you absolutely need to get evaluated to make sure that there's not a more sinister cause of what's going on. It's even helpful, even with that, I'm a hypochondriac, So even you're being like, oh, this could be more sinister is scary to me. But even the idea that getting a colonoscopy could help me take care of it, that there's treatments and things like that is calming in a weird way. Oh, absolutely.

I mean, there is incredible work being done by the colorectal cancer alliance. And one of the people who leads that effort is a young woman, Brooks Bell, who, she's very public about it, who had colon cancer at a very young age. And she just started a new campaign called Lead from Behind, I believe it's called, about about colorectal cancer awareness. And they've got Ryan Reynolds showing his colonoscopy when he turned 45. So I think it's so important for us to realize that this is not something that is an old people's disease. More and more, we're seeing it in younger people. It's an equal opportunity employer. You know, this colon cancer strikes young and old male, female, black and white and every color in

between. So one of the most important things you can do is to start to have a dialogue with your gut. For example, when you sit down to go, you've got to turn around and take a look, see what's coming out of the bowl. Is there blood? Is it funny looking? Is it a different shape? You know, what does it look like? What does it feel like to really be in touch with what's going on in your body? Okay, we've talked about so much today. I would love for you to just leave us with one homework assignment, something that's super tactical and specific and actionable that we could start doing two day to benefit our microbiome. I want to leave you with my one, two, three rule. I want people to do at least one plant at breakfast, two at lunch, and three at dinner.

But here's the thing, it's got to be different plants. And I want you to do the one, two, three rule. So that's going to be six different plants a day, every day. And every day I want it to be different. So that the end of five days, you are at 30 different plant foods. Okay. And I want you to write that down. So I want people to literally have their list and be like, okay, I got to 30.

I'm done. My show-off husband got to like 27 and one day one time. I think he was just throwing pumpkin seeds, whatever seeds he could find. Because as simple as it sounds, that is one of the most profound actions you can take that we know can shift the health of your microbiome. This stuff shifts pretty quickly. We know from a study that was done at Harvard published in the journal Nature that within about 30 hours of food hitting the gut, we can see shifts. not just in the microbes, Liz, but also in the genes that get turned on or off. And so this is relevant, whether you are a dedicated carnivore, omnivore, flexitarian, vegan, pescatarian, whatever you are, what they found in this study, it didn't matter what label

or how people ate in particular. You have vegans who don't eat 10 different plants a week. So the important thing is variety of plant foods. And so that's one of those simple things that I want people to do. So one, two, three, six different plants a day, at least five days of the week. I want you to get to 30. And the other thing I want people to do is I want you to go into your medicine cabinet and I want you to take out every prescription drug over the counter, supplement, tincter,

all of it. And I want you to look it up and see, does this affect your microbiome? What are the potential GI side effects? And I want you to also maybe even make a little list. Okay, this is critical. This is maybe. And this can go. And I want you to trim some of this stuff off because even if it's not affecting your gut microbiome,

most of these drugs are metabolized through our liver and our livers are tender, particularly if you are also having a drink hair in there. Our livers are tender. So I want you to think about maybe honing it down to what is really just absolutely necessary. And just to put a fine point on it, the things that are critical if we're doing all of the other stuff that we talked about in this episode, we can probably handle the critical things. We just don't want to overload with non-critical things. Absolutely. I have tons of patients who are on major drugs and they do just fine. So it doesn't mean that, oh my goodness, I took an antibiotic, all is lost. Or I have to be on a steroid. I'm sunk, not at all. for even for people who have chronic medical conditions, even for people who have to take these

drugs chronically, there's still a lot that you can do starting with what I just mentioned, the one, two, three rule to make sure that you're trying to optimize what's going on in your gut. Amazing. Well, I'm going to talk all about your beautiful book at the top of the episode, but I would love to hear a little bit about it from you in your own words and anything else that you want to share that you have going on. The book was really just a labor of love. I look at it as my public health message. and I feel like it fits so well with the larger public health message of what we can do. Of all the amazing things we have in our arsenal of social distancing and masking when appropriate

and vaccines and all the rest. But what I want to remind people is that the health of the host of you and I and all of us matters greatly when it comes to outcomes from viral illnesses. And we have very clear data on that. We have studies that show that the health of the microbiome. is more predictive of outcome after viral illness than anything else combined than age, gender, comorbidity, inflammatory markers, just by looking at the health of the microbiome. And so I want people to really take this as a call to action for some of these incredibly

simple things that they can do, just being aware of these host defenses, of stomach acid, of fever, of mucus, of the gut lining, gut bacteria, the role of sleep in helping optimize your immune system, the role of stress and sabotaging it, exercise all of these things. And I do love the plan at the end of the book, how to create an antiviral gut. So I do feel like this is my public health message to everyone out there so that we can all figure out how to be more resilient hosts. I also want to shout out the recipes. They look absolutely delicious.

And I'm like, if I can optimize my microbiome while eating yummy food, that's the dream, right? The recipes are by my friend Elise Muccellus, and she did the recipes for my first two books, Got Bliss a Microbiome Solution, and now this one, the third book. But I'll tell you, she's a fantastic chef. I'm a basic chef. And so all the recipes are few ingredients, not complicated. If the method section is more than a paragraph, it doesn't make its way into the book. So these are all recipes.

These are all things that I cook all the time. They're super simple. As you'll see, they're almost all plant-based. I think there are one or two in there that are not. and they're designed really to be batch cooked and to be used for any meal. So the food part with my books is always super simple and super delicious. Amazing. Well, thank you so much for taking the time to join us today, Dr. Chacken.

I immensely enjoyed this. Thank you so much, Liz, for having me on. You are a beacon of light and information out in the world. So thank you so much for doing what you're doing. Okay, this is definitely one of those episodes where I think I need to go back through and take notes because I learned so much from Dr. Chetkin. I absolutely loved how she broke things down to make them really digestible, no pun intended, with tips that we can all start incorporating into our lives today.

If you know anyone who would benefit from this episode, please shoot them a quick link to the podcast so we can all go outside and make it through cold and flu season feeling so much better. And also tell me if you try the soup. It sounds so good. I am so excited to make it. Before we wrap up, if you haven't already, go join the Healthier Together Podcast Club, Facebook group and join the incredible conversations everyone is having on there. I will link the group in the show notes or you can just search Healthy Together Podcast Club on

Facebook. You can find out more information on there about joining in-person podcast club if that is something that you were interested in as well. But there's also just like recipes and tips and tricks and takeaways from episodes and product reviews. And it's just a really wonderful and supportive place to hang out. So search Healthier Together Podcast Club on Facebook and it will come right up or I'll put it in the show notes.

If you're new here, make sure that you're subscribed so you don't miss out on any future episodes. We have amazing ones coming up, including an episode about overcoming fear of death, which is a little left field. But it was really helpful for me. And I feel like based on the response I've already gotten on Instagram, when I initially shared, I was going to do an episode on this topic. I think it's going to really resonate with you as well. And we also have a new Ask the Doctor Blood Sugar edition coming up. So subscribe, subscribe, subscribe. So you do not miss out on anything.

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