The Liz Moody Podcast - The Future of Gut Health: Cancer Treatment, Circadian Rhythms, Mental Health Advancements, and So Much More with Dr. Will Bulsiewicz

Episode Date: May 11, 2022

Today is a mega episode all about the future of gut health, so we can all heal our guts utilizing all of the ground breaking research that’s emerging in the field. Dr. Will Bulsiewicz is an award winning gastroenterologist, internationally recognized gut health expert and the New York Times-bestselling author of Fiber Fueled and The Fiber Fueled Cookbook. On this episode we talk about: the surprising reason humans kiss how the gut brain axis actually works the best protocols for helping mental health issues how to know if your blue light blocking glasses are working how to optimize the circadian rhythm of your gut microbiome the one gut health change that studies show dramatically impacts Covid outcomes the cutting edge gut protocols that we’re starting to use to treat cancer the best type of workout for your microbiome an exact protocol for before, during, and after taking antibiotics why most people are treating SIBO wrong the hidden causes of bloating and constipation that no one is talking about the first step to instantly make a stomach ache feel better the best time of day to take a probiotic when it’s important to eat organic and when it matters less Dr. B has generously agreed to give away 10 (!!) free copies of his amazing new book and 1 amazing grand prize of a free private virtual session with him.. To enter, just follow @theguthealthmd and @lizmoody on Instagram, and then comment on my most recent post one thing you loved or learned from this episode. This episode is sponsored by Nuzest. You can use the code “LIZM” for 20% off your order on http://nuzest.us/liz. This episode is sponsored by Seed. You can get 15% off your first month’s supply by going to https://seed.com and using the code LIZMOODY. This episode is sponsored by AG1 by Athletic Greens. Visit athleticgreens.com/healthiertogether and get your FREE year supply of Vitamin D and 5 free travel packs today This episode is sponsored by Paleovalley. Head over to paleovalley.com and use the code LIZM for 15% off. 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 cookbook author and long-time journalist. This podcast is all about helping you live your healthiest, happiest life, whether we're learning how to develop our personal style, busting myths about aging, or talking about the hidden parts of chronic illness. And yes, those are all real episodes, so if any of those topics sound good to you, scroll on back in the archives. Today is a mega episode, all about the future of gut health, so we can all hear that

heal our guts utilizing all of the groundbreaking research that's emerging in the field. I am so excited to welcome Dr. Will Bolswitz to the podcast. I had him on a while back for our Ask the Doctor gut health edition, and it was one of the most popular episodes ever. You don't need to listen to it as background before listening to this or anything, but if you want more gut health tricks and tips after this episode, definitely go back and find that episode. I will also link it in the show notes. Dr. B is an award-winning gastro, entorologists, internationally recognized gut health expert and the New York Times best-selling author of Fiber Fueled and the Fiber Fueled Cookbook. He sits on the scientific advisory board and is the

U.S. Medical Director of Zoe and has authored more than 20 articles published in peer-reviewed scientific journals, has given more than 40 presentations at national meetings, and has presented to Congress and the USDA. On this episode, All About the Future of Gut Health, we get into his best protocols for addressing the gut brain access to optimize mental health. How to optimize the circadian rhythm of your gut microbiome. The cutting edge gut protocols that we're starting to use to treat cancer. The best type of workout for your microbiome. An exact protocol for before, during, and after taking antibiotics. Why most people are treating SIBO wrong, the hidden causes of bloating and constipation that no one is talking about, and so much more. This is a long one, but that's because our

Gut health is so important and impacts so much of our overall health. And I wanted to give you as many tools as possible to help. We have an incredible giveaway for this episode. So definitely stay tuned to the end to find out how you can win a private session with Dr. B. Yes, really. And we would also both love to hear any tips or tricks that are resonating or that you're excited to try. So definitely take a screenshot and tag me.

I am at Liz Moody and Dr. B. He is at the gut health MD as you're listening. We have got a lot to cover here, so let's get into all things gut health with Dr. B. I would love to start just to kind of lay a foundational groundwork. We're going to get into some very cutting edge science around gut health, but just to lay some groundwork. Can you just speak to some of the things that your gut impacts that aren't just your gut? Can you speak to some of the things like both good and bad that the research shows that our gut plays a large role in? there's never been even one second in human history that did not involve microbes.

The story from the very beginning for every single one of us has involved these microbes. And as a result of that relationship that bore out through millions of years of co-evolution, we grew to trust them. And it's clear to me as a medical doctor how much we grew to trust them because we frankly rely on microbes to do things that are essential for human health. So I'm talking about digestion, which is like access to nutrients. That's basic. We need that.

That's life. But I'm also talking about our immune system and like shaping our immune system when we are trying to fight an infection or protecting ourselves. And also is the interaction between our microbes and our metabolism or our hormones. or our mood or our brain health or even the expression of our genetic code and you go down the line and I know we're going to dig in deeper this is just like I'm just kicking us off here just getting us getting the ball in motion but like you go down the line and you see that what I'm describing here are the pillars of human health and what I'm saying to you is this isn't the only thing that matters but part of what matters

in the pillars of human health is not even human it's your gut microbes we're completely interactive and intertwined. And so what I mean by that is that your microbes are shaped not just by you and your genetics, but also by your food, which many people know this, but let's take it further, sweep and exercise and the environment in which you live and the people that you share your space with, like who you cohabitate with, and whether or not you have pets, and whether you live in a city or out in the country. And then the last thing like having a holistic view includes an understanding of where are you at from an emotional perspective and what's going on in your non-conscious mind. Are there things that are bothering

you? Is there something that's upsetting you? Even if you aren't fully acknowledging it? And those things can potentially have an effect on the balance of these microbes. And this is, perhaps we'll dive deeper into this, but this is the reason why during times of stress, many of us will manifest digestive symptoms like bloating gas cramping diarrhea during times of stress we manifest those symptoms and that's because our emotional state actually informs the state of our gut. So let's just dive into a few of those things that you said. If you live with somebody who has some sort of dysbiosis, is that going to make you more likely to have some sort of dysbiosis? I've never seen any evidence to say that's the case. I haven't seen any evidence to say

that we make each other worse off. What if we're making out? All right. So making out, this is an interesting topic. Why do we do that? Right? Like, why do all humans in all cultures from around the world feel compelled to kiss when they are expressing affection?

Are we, wait, I have a guess. Is it because we're testing each other's microbiomes to see if we're like compatible on a microbiome level? Well, this guess that you just threw out there. I mean, you know who you're talking to here. So I'm pretty sure that was informing the guess that you were making. But yes, you are correct. They've actually demonstrated that a good, like I'm not talking about a pack, like a grandma pack.

I'm talking about a good, passionate kiss. Actually leads to the transfer of about 100 million microbes. And the theory is that, I mean, I think we've all been there. So where like you do feel attracted to someone and then you kiss and it's just not there. You don't like their microbes. Is it that our microbes are telling us that something is wrong? And so then we go in a different direction. Maybe it wouldn't be like an ideal procreation situation, maybe, and that's what our body's telling us.

Or let's move it in a slightly different direction, but kind of on the same page here, talking about looking for love. We know that our microbes actually are responsible for producing our body scent, right, which includes our pheromones. Now, have you ever been, this is like a rhetorical question, you're not personally required. to answer this way, but this is for the people at home. Have you ever been on a date? And like, you've physically attracted to the person, but you notice that the smell is just off. And it's not that that person's like smelly. It's that the smell is not compatible with you. And someone else will love that smell. Someone else will be like, oh, my goodness, this person smells amazing, right? So could that be our microbes? So to move this into the idea of like

cohabitation. They actually have a really cool study that came out recently that I'm excited to talk about where they looked at the shared microbiome between people who were living together and I believe living together in a romantic relationship. So not just like roomies. And they discovered number one that people who cohabitate actually share more microbes than a person would share with their sibling. So, for example, I share more microbes with my wife than I would share with my two brothers, even though my brothers and I share genetics. And we can't come from the same mom, right? So now that's interesting. The question comes up, is it our food, right? Because it's like, okay, so I live with my wife. So we're obviously reading like, you know, dinner together every day.

Is it just that we're sharing the same food? So they controlled for that. And they said, after controlling for food, we still discovered that, like, people who cohabitate are sharing microbes together. Which is really interesting because then that would have implications on, like, how much of your microbiome is set at birth. And I know people talk about, like, the zero to three years of your life, but how much of that is malleable through the later stages of your life, which would be really good news for affecting that in a positive way, wouldn't it? I think it's quite malleable.

And if you look at this, so first of all, there are eight billion people on the this planet and there's no evidence that two people out of $8 billion have the same microbiome, that we are all so unique and distinct. This is a very big part of what makes us like individual. And if you look at identical human twins, right, so like two people from the same family and they like literally share the same genetic code, they actually only share about 35% of the same microbes. So that shows you the power of like the world.

in the environment relative to genetics and like what you receive at birth. Okay. So if that is true, though, and you live with somebody whose microbiome is in a state of distress, how would it go that that wouldn't impact you negatively at all? I would actually venture to say that, well, you know what, let me come back to the study that we were talking about and then I'll answer that. Is that cool? Okay.

So in this study, what was fascinating is that they discovered that not everyone, who cohabitates shared the same amount of microbes. And they started asking the question, what is it that defines this? Separating like a lot of sharing versus not much sharing. And they found, this is, I love this, they found that people who are in a very connected, connected relationship where they're in love,

they're sharing a lot of microbes. Is that because they're like, you know, exchanging fluids more? This is a valid question. Is this because of intimacy? Yeah. Or is it that, so consider this. Like, Liz, I'll just speak for myself.

I'm as guilty as anyone of like overemphasizing nutrition. And there is so much more to health that goes beyond what we eat. And some of the most impressive data that exists in terms of longevity, like how do we live longer lives, have to do with social connectedness? We are social creatures. It's hardwired into us. And if you want to torture a human, you isolate them. And if you want to bring out the absolute best in a person, you support them and you make them feel loved.

And then they feel safe because they know that they got a tribe or someone standing behind them. So like how does this work? How does that actually manifest into the gut in a physiologic way? Like not even being, not being woo-woo about it, but like let's get into the nuts and bolts of it. So I kind of alluded to this a little bit earlier, but I want to take it deeper and further. In times of stress, our brain will actually initiate the stress response and release a hormone

called CRH corticotropin releasing hormone. And this triggers a cascade of events in the body. But if you follow this waterfall down, what you're going to find at the bottom is that it actually is inflicting injury on the gut microbes. And so when a person is living in isolation and not feeling supported, they are more prone to having ongoing activation of this sympathetic nervous system, which is basically undermining their health. On the flip side, when a person is feeling loved and supported, independent of whether they're kissing and having romance with their spouse, independent of that, this person feels loved, feels supported. and that is naturally going to reduce that sympathetic drive. And in reducing that sympathetic drive, we actually have evidence that you can actually heal a gut microbiome.

So a huge maybe under-discessed thing in terms of having a healthy gut would be to have human connection, to have positive relationships in your life. Having human connection, having positive relationships, and being at peace with yourself and the world in which you exist. Okay, let's talk about the gut brain access for a second. I think we hear a lot about it without having a really great understanding of what it actually means. So can you explain in the simplest terms what's going on there? So we think of these organs in isolation.

You might think of your gut or your heart or your brain. But in fact, the body is one body and everything is intertwined. And you really can't separate them. The gut is communicating to the brain literally right now as we speak through a number of different ways, through nerves, through neurotransmitter. through special molecules that your gut microbes create. Meanwhile, the brain, we've already talked about CRH and how the brain can affect your digestive function. Your brain is talking to your gut as well.

So it's really a two-way street of communication. Are there specific probiotic strains that target the gut brain axis? I think it's fair to say that there are and there are many. And the challenge or the issue is the, so one of the things that I want people to to understand is that we focus on individual strains because for research purposes, that's pretty easy. But the gut is more about how does the gut function? And the gut functions in teams, not as individuals.

So ultimately, there are probably multiple combinations of microbes that end up becoming very relevant to these questions that you and I are speaking about. With that in mind, it doesn't make sense to be looking for like a probiotic supplement that includes this strain or this strain or this strain with the idea that if I have anxiety, it would specifically help with that because it's just a small, studyable piece of a much larger story. It might work for some people. Let's pretend that you have generalized anxiety disorder.

Oh, I do. So it's not even hard to pretend. Okay, cool. So let's pretend that you personally, Liz, that you take a probiotic. All right. And you notice that when you take this probiotic, you have an improvement in your mood. I don't care what the research says at that point because you personally introduced this microbe into your personal ecosystem and you are deriving a benefit from this.

Flip side, let's pretend that we have a probiotic that it says, this is great for generalized anxiety disorder. Like I have a randomized controlled study to prove it, right? So Liz Moody runs out and grabs this at the store and you take it for a month or you take it for two months and you're like, I haven't even noticed any difference. It's not a fit for your personal gut microbiome. It doesn't matter what the randomized control trial said. This is the problem with randomized control trials. They're great.

But ultimately, we are looking at the results of average populations or average people. We're not defining it by the individual user. And the real question is, how do we ultimately get results? for the individual, because that's what we all care about. And I think, though, that people are looking for those broader recommendations, though, because there's so much out there that's promising to, like, for that example, that's promising to help with my anxiety, that it's hard to know where to start sometime. So that's why you're like, well, what's the best probiotic that's going to help with my anxiety?

What's the best lifestyle practices? Because if you're just like, well, I'll try everything and see what works for me. Like, I don't have enough time in my life to do that. Yeah, totally. No, I think that makes a lot of sense. And I think that the important point is we also have to tailor to the individual user, right? So context becomes very important. And so we can't just like paint with such broad strokes.

You know, when I write a book, I write a book for the masses. But if I were writing a book for Liz Moody, it would be a different book. Okay. Well, if you were writing a book for somebody who was looking to sort of optimize the mood benefits of a balanced microbiome who is trying to kind of optimize that gut brain axis, is there any other? tailored recommendations that you would make as a starting point. Have you tried Ashwaganda? I think it's amazing.

I've used it myself. So it's an adaptogen. It helps us to handle our stress. I've noticed this firsthand because in my life I've taken a lot of call as a medical doctor and you have random like sleep deprivation moments and it's hard to work the next day. And by including Ashwaganda, it keeps me even imbalanced. I've seen great benefit to people introducing Ashwaganda for whether it be anxiety or with depression. You know, we're not talking about a medication here.

So I think the level of intensity is relevant as well. Like are we talking about mild or moderate or severe? With anxiety specifically, you have to be careful with caffeine. You have to be careful with alcohol. These are things that can certainly trigger and make it worse. I think getting a good night's rest is super important. So what I would really encourage a person, who has anxiety or depression is be mindful of your daily rhythm.

And so what I'm saying is not only do I want you to get like truly eight hours of sleep, I know that's not easy for everyone, but I also want you to like not use electronics late at night. And they have these blue light blocking glasses. Have you ever tried those? I have. My husband tested a bunch of the popular ones and found that they didn't actually black blue light, but then if you get to the ones that are, for lack of a better word, really ugly,

they do? And then I'm like, well, do I want to wear those? I don't know. I don't wear mine in public. But I don't. But the question is, how do you know if they're working? And I'll tell you how. Okay. When you use them, you have vivid dreams. Does that imply more REM sleep? Or? It implies more REM sleep. That's where we have our most vivid dreams. And the key here is that your body naturally produces a hormone called melatonin. Melatonin supplements have become very popular. But it's like a strange compensation that we're doing because we're doing things that suppress melatonin like exposing ourselves to bright lights late at night, you know, phones, tablets, computers, TV. And then we're supplementing melatonin in an unnatural way when instead we could just wear the blue light blocking glasses. And then it presuppose. your natural melatonin level, and you get a good nice rest. That's how you know it's working. 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 in my mattress. And in fact, I have four years well before I had much money to spend on any of these things because it is such a big needle mover. The birch mattress is incredible. It is made with organic cotton, natural latex, and ethically sourced wool. So it has literally no off-gassing.

You can not smell anything right when you unbox it. It has no micropastics, no synthetic foams or flame retardants. and the wool makes it so breathable, which if you've listened to this podcast for more than five minutes, you know that I run very, very hot, like I am a furnace. Zach has basically accepted that sleeping next to me is like sleeping next to like a little fire. And the birch mattress has been a game changer for that. It's made me sleep so much better like I can see my sleep score going up because I'm not hot all night long.

It's also hypoallergenic, which is really worth paying attention to if you find yourself waking up stuffy or congested. Dust mites in a conventional mattress can actually impact your breathing and your sleep quality without you even realizing it. And again, we need to be able to breathe to get good sleep and getting good sleep is the foundation of our health. And then comfort wise, Zach sleeps on his back and then I sleep on my side and my stomach. 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.

Birch 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. Burch ships right to your door. It sets up in minutes and it comes with 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 birch living.com slash Liz Moody for 20% off. That is birchliving.com slash Liz Moody. And you're going to get 20% off birchliving.com slash Liz Moody. When you think about strength and resilience, like your ability to feel energized, to recover well,

to stay strong as you get older, what do you think that actually comes from? Most people say working out or good nutrition. And yes, of course that matters. But there is a biological foundation underneath all of that that most people are completely overlooking. I have been diving deep into this lately with the team at timeline and what I've learned has genuinely shifted how I think about my own health. Every single movement that your body makes every step, every workout, every muscle contraction depends on energy produced at the cellular level. And at the center of that is your mitochondria.

Here is the thing that nobody tells you, certainly nobody told me, starting around age 30, our mitochondria naturally become less efficient. More get damaged, more become sluggish, and over time that impacts your energy, your strength, your recovery, and your resilience. Most of us respond by pushing more. We're like noticing these things and we're adding in more protein. We're trying to fix it with more supplements. We're trying to do harder workouts. And those things do help. But timelines research suggests that we also need to be supporting the cellular machinery underneath. And that is exactly what their supplement might appear does. It contains urolithin A, which helps your body clear out damage mitochondria and support

healthier ones so that your cells can produce energy more efficiently. Because this is happening to your cells, it's going to impact your entire body, your immune system, your muscles. One study found that taking mitochondria increased muscle strength by 12% in four months with no change in exercise routine, it's going to impact your energy, your sleep, your skin, your cell health impacts all of this, and urolithin A keeps your cells healthy. Timeline has done over 15 years of research and testing on this one product, Eurolithine, which, by the way, most of us lack the gut bacteria to synthesize naturally. That's why many of us need to supplement it to get the benefits.

This has become a staple supplement for me. It is my top way to support how I want to look and feel as I age. Support your cells and how you age with mitochondpure gummies from Timeline. Visit Timeline.com slash Liz and save up to 39% on. your mitochondrure gummies. That is timeline.com slash Liz. We're sort of like dancing around the idea of a circadian rhythm, which I'd love to talk about more in depth because I think if we're talking about the future of gut health or the future of all types of health, becoming more aware of how our circadian rhythm impacts basically all parts of our body is just, it's going to be

more and more important. We're going to have more and more research into it. So I would love to get your take on how your gut health impacts your circadian rhythm. And, And conversely, how your circadian rhythm impacts your gut health. Our gut microbes have a circadian rhythm as like so do we. So when we think about ourselves as this superorganism, we have to bear in mind that the gut microbes have a circadian rhythm too. You could feed a person the exact same meal at different time points during the day and you will get different responses in terms of their blood sugar. So like literally oatmeal for breakfast or oatmeal for dinner, higher blood sugar when you give them the oatmeal at dinner. our gut microbes.

So there's one common bond when we talk about evolution and all life on this planet, which is that every single living creature on this planet evolved with the rise and the fall and the sun. There are many different circumstances that can vary, but the one circumstance that was always there is the sun goes up and then the sun goes down. And so that's really what ultimately led to us developing a circadian rhythm and it does affect our gut microbes. They thrive on consistency.

When we shift meal times around, we're messes. with that consistency that they want. When we shift sleep times around, we're messing with them, right? When we sleep at a certain time during the week and then we go out until three in the morning on the weekend, and then you wonder why you're so hung over. It's not just the alcohol, right? So there's these layers of complexity where our body truly thrives on a rhythm. I would go so far as to say this is our circadian rhythm, but it's also like even our gut,

our gut thrives on a rhythm, good, regular, complete. bowel movements, that's a big part of what makes our gut work best. You mentioned the oatmeal example. Are there any other things that your gut microbiome likes at specific times of day? Our research is actually showing us. This is research coming from this company, Zoe, that I work with. We've published more than 40 papers. One of the studies that we have, we showed that late night food consumption actually increases

inflammatory markers, and they can perpetuate almost until the morning. So the idea of fasting, like time restricted eating, this to me makes a lot of sense in part because we're having hopefully an earlier dinner time and then we're avoiding this pitfall of late night snacking. And because that late night snacking again is like basically creating an inflammatory environment that your gut never actually truly recovers from because then you wake up the next morning and you hit it again. Okay.

So even if you're not looking to actually fast, having your dinner. on the earlier side? Is there at least to get really granular? Is there a time that you would view is sort of like a cut off, like an amount of hours before bed that you would recommend having your dinner? I think in a perfect world, people are having their dinner, like certainly before 8 p.m. Ideally, to me, before 7 p.m.

And then part of it is the amount of time in between. So, like, after you have dinner, you can drink water. You could have tea from my perspective. but you want to try to avoid eating solid food. And if you give that 12 hours and you wait until the following day, then actually our studies would suggest that 12 hours without eating food is actually adequate time to allow the gut to heal and reset itself. Fasting is an interesting one for me because I've heard really mixed reviews on like

fasting is great because it gives your digestive system a quote unquote break, but also that fasting can be more negative because at a certain point your microbiased. starts to like digest itself or digest your cell walls or something like that. What is your take on fasting in general? Fasting for more than 24 hours. It's suggested that actually is harmful to the microbiome because they actually are no longer being nourished with their own food supply. So then they start consuming this mucus layer that lines the intestines.

So 12 hours of fasting is a healthy amount of space to allow your microbiome to rest. 12 hours is very easy. Many people don't even consider that in sort of the fasting space. I think where we run into trouble with, like so many things, is that when we hype things up to the point that people think this is like the shortcut to human health, then we double triple, quadruple down on it, and we go too hard on it, and we lose sight of the fact that this is just one tool and it's just one part of what makes you a healthy human. Totally agree.

What about snacking in terms of that? Like, do you think that giving your digestive system a break between meals is important? Generally speaking, this is actually something that we're looking into as well. So we're starting to study snacking in more detail. What we're finding is that the quality of the snack is difference making. So when you eat a high quality snack, then it actually doesn't cause metabolic harm. When you eat an unhealthy snack, then it actually disrupts your metabolism. And it makes you far more likely to overeat during the day.

Okay, so there's not like a gut. I've heard about like the, is it the like these sweeper cells that come in when you have three to four hours of not eating that come in and kind of like clean out your intestines. And if you don't have those sweeper cells be activated, you can cause digestive issues down the line. Is that not true? So you're referring to our normal bowel motility and specific sort of movements of motility that. that occur. And I, so I think that taking a break between meals makes sense. I think that it makes sense. Now, whether or not, like, speaking to the motility like that, it's more of a theoretical take. I think the question is, like, is snacking if it's healthy food actually causing harm to our body? I have not seen evidence that that is the case. But this is something that we're continuing to look into in more detail. What, just in a very, like, quick way, what do you consider a high-quality snack versus a low-quality snack.

Are there factors that make something a high-quality snack? I would describe it as less processed. So to me, like, you know, eating a handful of raspberries is clearly a high-quality snack, right? And people don't necessarily think of that as a snack, but why not? So, you know, we're eating an apple as opposed to eating a bag of chips. I would love to get into our immune system. I think that's especially front of mind for people these days. for obvious reasons.

I thought it was really interesting in your book, how you talk about the relationship with COVID and our guts. So I would love to start with maybe the more negative side. And then we'll get into some of the really, I don't know, interesting, beneficial, exciting research you were sharing in your book. But is there research that you can share about the impact of getting COVID on our gut? Yes. So as we move into talking about the immune system,

just to refresh everyone, 70% of the immune system lines the intestine. And there's literally just a single layer of cells that's so thin that we can't even see it with the naked eye that separates the 70% of your immune system from your gut microbiome. So they're actually interfacing and talking to one another constantly. So with regard to COVID, there was research that came out in January of 2021 in the journal gut, the top European Gastronology Journal, showing that people who have COVID have changes to their microbiome. And as you look at the severity of COVID, these changes become even more apparent. And specifically what they were seeing, and this is actually strikingly similar to what we see in people that have depression and anxiety, is that there was a loss of the short chain fatty acid producing microbes.

And there were more of the inflammatory types of microbes. So now, this is interesting because it would suggest that maybe, B buterate and the short chain fatty acids that we get from dietary fiber turn out to be very relevant in the setting of COVID and COVID severity and how it manifests with us as individuals. Because we've been asking since the beginning, like, why does one person end up in the ICU, while another person has the sniffles or nothing at all? So, and what we have found in a different study is they took a look at health care workers. This was, by the way, before vaccines were available.

and from six different countries, and they assessed their response to COVID and their diet. And they found that when people were eating a plant-based diet, basically high in fiber, that they had a 73% reduced likelihood of having moderate to severe COVID-19. People who were in a pescatarian diet, like mostly plants, but with some fish,

had a 59% less likelihood of having moderate to severe COVID-19. And then flip side, those who were eating a low-carb diet actually had the highest risk of moderate to severe COVID-19, they were basically four times more likely to get moderate to severe COVID-19 if you compared them to a plant-based person. Now, this is not like a diet war thing. I just, I don't really, I'm not interested in that. I'm interested in the science. But what I think is happening here is that when a person does low-carb, if we brought in a nutritionist,

they could create a healthy low-carb diet. But most people, they just look at how many carbs. And fiber is a carb. And so when we go low carb, we are reducing our fiber intake. And I think that's what you're seeing reflected in this study is that fiber becomes very key in terms of its interplay with our gut microbes and producing these anti-inflammatory short-chain fatty acids that we need to shape our immune system. There's new research that's coming out that's blowing my mind.

And I want to share it with your audience because one of the things with microbiome research is that like in the past we were mostly just describing what we were seeing, but now we're entering into this exciting new phase where we're manipulating and we're changing health outcomes. And one of the places that it's super exciting is in cancer research. So in the treatment of melanoma, which is the number one most deadly form of skin cancer, they will typically use what's called immunotherapy where they are shaping the immune system and using the immune system to fight the cancer. And so if you go back a few years ago, they did a, they found, they had a study, where people who were treated with antibiotics, like an antibiotics, like injuring the microbiome,

were more likely to have bad health outcomes from melanoma despite treatment with immunotherapy. So then they're like, interesting. Maybe the microbiome is relevant. What happens if we give a person a fecal transplant? So they gave, this is at MD Anderson, one of the top cancer centers, and the person kind of leading the charge here, Her name is Dr. Jennifer Wargo. So they gave a fecal transplant before immunotherapy. And people who received a fecal transplant were more likely to have eradication of their cancer and survive.

Now, more recently, in December of 2021, in the journal Science, which is most people consider it to be one of the top three or five scientific journals out there, in the journal science in December, they looked at people's diet. and they separated people into high fiber consumers and low fiber consumers. And the theory here was because they had noticed that people who responded well to cancer therapy had higher numbers of the buterate or short chain fatty acid producing microbes. So they took a look at like if you ate more than 20 grams of fiber, which is not many people in the study, or you ate less than 20 grams of fiber. Now, just to frame this, 20 grams of fiber is actually still deficient. The recommended amount per day for women is 25 for men, it's 38.

In this study, though, if you ate at least 20 grams of fiber per day, you were more likely to survive and be free of melanoma with immunotherapy. To the point that every five, think about this, five grams of fiber, every five grams of fiber led to a 30% increased likelihood of survival. And it parallels colon cancer research, where they've looked at diet after a person is diagnosed with colon cancer. And they find that for every five grams of fiber for those people increases their likelihood of survival by 18%. Wow. Crazy. Yeah, that's wild. A lot to unpack there. A few things. One, is fiber the best way to increase those short chain fatty acid producing microbes? Are there other ways to have that

out to have that effect? The short chain fatty acid producing microbes are are present because they are breaking down fiber. So if you want more short chain. That's why they exist. That's why they exist. And they will be enriched and become stronger and more powerfully represented when you have fiber in your diet. Now, fiber is not the only way to enhance these microbes. I actually personally was involved in some research with Professor Anna Valdez and and Rita VJ, who are at Nottingham University. And we did an exercise intervention and showed that exercise enhances the growth of the short chain fatty acid producing microbes. Was there a specific type of exercise that you guys were using? Well, the exercise intervention was among people who had osteoarthritis.

And it was, I believe it was 15 minutes of exercise per day. So, and it was, and it was, weight bearing, but I mean, again, like 15 minutes is not too much. I mean, basically what we're saying is you do a little bit of exercise. You just move your body and it could potentially help with your gut microbiome. Do you have an instinct as to whether, you know, cardio or weight bearing or yoga, like whether there's a best type of exercise for your gut microbiome? Okay. So one of the things that you've heard me say is diversity of plants.

Yeah. Are you going to tell me to do diversity of exercise? Diversity of exercise because specific exercises affect specific microbes. In fact, Oh, that makes sense. They've discovered that people who are runners will actually shift their microbiome towards specific microbes that break down lactic acid. Oh, that's so interesting.

Because when we run, we accumulate lactic acid. That's how we like, you know, have muscle fatigue or cramps. And so we actually have adaptations of our microbiome as we build up. and train for a marathon, our microbiome is adapting with us in order to facilitate what we're trying to accomplish. That's crazy. Okay. So to have our most optimal microbiome and to support those short chain fatty acid producing

microbes integrate different types of exercise. Yeah. And what was it that Tony Horton used to say with P90X? It was like muscle confusion, right? Basically what he's saying is the same thing that you and I are talking about, like diversity of exercise, like do different stuff. don't just do the same thing every single day. If you had to prescribe a dose of exercise for us to all do just in terms of our gut health,

what would you write on your little prescription pad? So I want to meet people where they are. So it depends on the individual, but let me put it this way. If you give me a 30-minute brisk walk after dinner, I'm a very happy doctor. And after dinner, do you think there's benefits? I had another episode about blood sugar, and she talks specifically about exercising to elongate your blood sugar curve after meals. Do you like doing that for your gut microbiome as well?

I do. And actually increases bowel motility, helps us to empty our stomach. And it does help in terms of our blood sugar and metabolic control as well. There's a number of health benefits. And it probably involves when you hear that there's metabolism and blood sugar control, we are talking about the gut microbes, not exclusively, but we are talking about the gut microbes. Just know they're a part of that story. So would that mean that fasted workouts are not?

ideal on the flip side? Or they just, our fasted workouts, fine, but they're maybe not harnessing the extra benefits we could be getting of a workout by doing it after a meal. I don't think it necessarily has to be after a meal is. I mean, I don't think people who are doing fasted workouts should feel bad about necessarily doing that. This is where I do think that there's a place for an intuitive approach where listen to your body and see how you feel. That's what I would say. And then when we're talking about the gut and the immune system, I want to bring up a paper, a study from, this is what was this in? This was a cell, which is a journal.

And this kind of gained a lot of traction because it was on a very popular health podcast. And it talked about the difference between a high fermented food diet and a high fiber diet in terms of eliciting a really positive immune response. And I think the interpretation on that podcast was that maybe a high fiber diet wasn't as important as a high fermented food diet in terms of supporting your microbiome. I would love your interpretation of this study. Right. So we're talking about a study by actual friends of mine.

So Professor Christopher Gardner is at Stanford, and he serves on the scientific advisory board for Zoe with me. And Professor Justin Sonnenberg is also at Stanford University, and he actually endorsed fiber-fueled. And if you listen to the actual authors of the study, I can assure you they are not telling people to not consume fiber. to be more clear because that was a weird way of saying it, they are beyond encouraging a high fiber diet. The actual authors of the study are beyond encouraging a high fiber diet. Now, we could get super technical and we can like really dig into this study. What's exciting about the study was that in 10 weeks, by adding fermented food to their diet

because people really were not eating fermented food, in 10 weeks they were able to enhance the health of their gut microbiome by adding this new food. Now, the story with fiber is very complicated. I think that to really unpack this would probably take us about 10 minutes to really dig through. But the point is this. There is no one size fits all. There is no one size fits all.

And healing your gut and optimizing your gut needs to be done in a way that's unique to you. And so when you take a large group of people and you tell them everyone like, yo, because they went from 20 grams of fiber up to 45 like very quickly. So you'd say to everyone like more than double your fiber super quick, that's not going to work for everyone. one. And the people who did not do well with this fiber change were the people who had low diversity in their microbiome at baseline. These are the people actually who need the fiber the most, but they're also the people who are going to struggle the most to ramp up their fiber. I cannot say that I'm surprised by what they saw in the study, because if you tell me that a person has a less healthy gut, I'm going to tell you right now, we have to take it low and slow to ramp up the fiber

in their diet. That's part of the nuance. So would your takeaways from the stuff? If you were putting it into practice, be add fermented foods in. And then if you haven't been having a high fiber diet, don't add it in all at once, but sort of ramp it up slowly. Is that fair to say? My takeaway from this study, the main takeaway from this study for me is fermented foods are fully on the map for gut health. This is no longer a woo-woo like alternative medicine thing. this is one of the top journals in all of medicine showing us that what people have been saying is real. So it's very exciting because this is another tool in the toolbox.

This is part of the reason why in my new book, I'm going to teach you how to ferment because I think that this is something everyone should be doing. But when it comes to fiber, as I've been saying from the very beginning, low and slow is the tempo. And that's a Beastie Boy song, but that's also a D.Eyy. Dr. B's mantra, we have to start at our individual place and allow our body an opportunity to adapt because the beauty is this. Here's the key point, Liz, your gut is adaptable. It can be trained. It can be made stronger. You can restore function that does not currently exist. But you have to allow your body an opportunity to adapt to what you're doing. If you were training for a marathon, you wouldn't jump out of bed and run 26 miles. You would work your way through a

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Can you speak to briefly why fermented food helps your gut? I think I had the idea that I don't think is correct, that you're putting these extra microbes in and those microbes are changing your microbes. But when I'm thinking about that, it must be such a teeny tiny amount of microbes compared to the galaxies of microbes I already have in there. So why is fermented food beneficial?

You are sending a wave of goodness down to your gut, microbes, and these are gut microbes that have been frankly starving because if I go out in the street, 19 out of 20 people that I walk into are not even consuming the minimal recommended amount of fiber. So with fermented food, what you're sending down is the gut microbes, but also within this ecosystem, because it is appropriate to call it that. These microbes are hard at work transforming the food and bringing out the best of it. They create new vitamins. They create new forms of fiber. They transform the polyfeas. So you are creating the availability of new nutrients.

And these new nutrients are basically going to come down, not just the microbes, but like the new forms of fiber and the polyphenols are going to have a prebiotic effect where they feed and nourish families of microbes. And this is why fermented food is so good for us. It's a transformation of the food that takes place before we ever even eat it. So going back to, we were talking about COVID and the immune system. We're talking about all of these things that benefit are short chain fatty acids to help our immune, or short chain fatty acid producing microbes to help our immune system.

If somebody has long COVID, how would you have them work on their gut to improve their immune system? Or is there any sort of protocols you would recommend there? All right. So here's what we know about long COVID. New microbiome data that actually was published fairly recently where they looked at people with long COVID. and discovered that there was a disturbance within the microbiome. Surprising? Of course not, but it needed to be shown.

And what they showed was, once again, very similar to COVID-19. People who had long COVID had less short-chain fatty acid producing microbes. Now, drawing a parallel to what we saw in COVID-19, we saw in COVID-19 that people who were frontline healthcare workers consuming a plant-based diet were 73% less likely. to get moderate to severe COVID-19. In long COVID, we're seeing the absence of the short chain fatty acid producing microbes. My recommendation based upon what we know today

is that people move towards enhancing the fiber, adding more plants into their diet. And it goes back to what we were talking about with exercise, how that can support the short chain fatty acid producing microbes as well. Let's do those things. We don't yet have a clear study, but here's my prediction.

I think that in the next year, year, we will have a study and we're going to see similar stuff that fiber proves to be beneficial in terms of preventing and ultimately treating long COVID. We've talked about exercise. We've talked about sleep. We've talked about reducing stress and having positive community benefits. I'm curious if there are any other daily practices that we should be adding in that are particularly beneficial to our gut.

I'm curious your thoughts on things like saunas or cold showers or. any other of those types of like practices that we haven't spoken about yet. I haven't seen any good data on cold immersion therapy in terms of the gut microbiome. I haven't seen it. I do think like ultimately at the end of the day, if you have a ritual or a practice that you find actually makes you feel more comfortable and at ease, tapping into how you feel is very relevant. It comes back to what we were describing earlier that if you have something holding you

back that's stressing you out. Having a way to actually address that, I think is sort of what we're talking about. So, you know, what else can we do? They had a study where people literally put their hands in dirt for two weeks. They didn't do anything else. They were not gardening. They just put their hands in dirt. And actually their gut microbiome got healthier. Okay. So like play dirty. So go attach some dirt. Yeah. Yeah. Play dirty. Like don't don't just, don't just, you know, like, Like, stay inside, like get outside and put your hands in the dirt a little bit. I think that getting back to a circadian rhythm that we were talking about, I think that light therapy. So I talked a lot about evening and how we reduce light exposure, but let's flip it on its head and go to the morning when you wake up.

We want that bright light exposure. We actually want that. And so light therapy, if you're able to just going outside for 15 minutes can accomplish this. but alternatively you can also buy basically bright lights that you would use inside your home. And our family, we've actually used these Liz. I don't know if you've ever used them. But I actually have found that I sleep better when I'm doing this. What about meditation?

Is that something that we should all be including if we're trying to take good care of our guts? I think that we should have a self-care practice. And meditation is an example of how we could have a self-care practice. I think there's different things that work for different people. And which one you're going to actually do is probably what matters. the most, right? So, like, if you never do it, then what's the point? There's actually data that show that yoga, so yoga, of course, not only exercise, but has a meditative element that people who have your oral bowel syndrome improve as much with yoga as they do with medication.

Wow. That's so interesting. Is that thought to be the meditative part or something about how you're actually physically moving your body? I'm picturing like the twists and things like that helping somehow inside what's going on. Yeah, we don't really know. know the answer to that. I have to venture my personal guess that it's a little bit of both, right? Because we spoke earlier a couple times about how exercise can enhance the gut microbiome and yoga is good exercise. Yeah. Depending on the kind you do. I like the kind where I just kind of lay on my back and don't Chivasana, just like shavasna for like a half hour. Shavasna is my favorite pose. That's my favorite post by far. Okay, I have promised people this. I would love your full protocol for when you have to take antibiotics. I would love

to speak to the before if you happen to know in advance that you're going to have to take antibiotics, like for a surgery or something like that, and then anything we should be doing while we're taking them and anything that we should be doing after taking them. So the first thing, the most important thing is, like, we first need to determine, are the antibiotics necessary? And this is the nuanced part, because I do not want to villainize appropriately used antibiotics. I actually strongly encourage them when they're appropriate. It's just that we know that prescriptions, when we look at studies, prescriptions for an antibiotics, 70% of the time, they're not necessary. So questioning your doctor or the health care provider and having that

caution before you actually engage in doing this is important. And this is, I may be opening a can of worms here, Liz, but this is why I get very nervous about the way that we approach CBO these days, small intestine bacteria overgrowth, because the knee jerk response is, oh, I have CBO, therefore, I will take antibiotics, or therefore I will take antimicrobials. And I worry that we're doing more harm than good in actually doing that. So we can unpack that further if you want to. I'll leave that up to you. But with regard to the antibiotic protocol, I want people actually supporting their microbiome

before they ever even take the antibiotic. We actually have studies suggesting that people who are on a high fiber diet, their microbiome gets less disturbed by the antibiotic and recovers more quickly. It's kind of like digging a hole and then trying to get out of that hole. The hole is a lot smaller if you're already consuming a high fiber diet. So you can like kind of jump in and jump out real quick. After the antibiotics are over, keep the fiber, keep that rolling. I would really encourage people like avoid sabotaging your own gut health in that moment.

So what I'm saying is now is not the time for a big night of drinking. now is the time for, or like now is not the time for a junk food diet. Support your gut, get your sleep, get your exercise, give it at least two weeks is the ideal. At least two weeks, preferably four. And we know that during this period of time, your gut microbes will recover. Real quick, people often ask about probiotics. The answer is almost always no for probiotics because there was a study in the journal's cell in, I think 2018, suggesting that when you take probiotics after antibiotics, it actually

slows the recovery of the microbiome. So unless you are a person who is specifically trying to protect against C. difficile, unless you're that person, I generally do not recommend probiotics. What if you're a person, the reason I was always told to take probiotics when I'm taking an antibiotic is to avoid a yeast infection. Is that not something that would happen? It is something that could happen. And if you find that there's benefit to taking the probiotics, the probiotic in terms of protecting yourself from that, to me, that would be a valid reason. Like, if I had a patient that I was individualizing for, I would certainly consider that. Are there any supplements that you would recommend during that period where you're kind of

really trying to rebuild your gut microbiome? I think a pre-botic fiber supplement comes in handy in that particular case. So, like, it could be wheat dextrin, acacia powder, partially hydrised guargum, Cillium husk. These are some of the options. I want to just touch on this briefly because I do want to have time to get into reader questions. But you mentioned SIBO and I know that's something that a lot of people do struggle with. And you seem to have kind of a different approach to how you would treat that in your practice.

Can you speak to what you would do if somebody came in and was worried that they had SIBO? Yeah. So it's a tricky thing. People just want to feel better. That's the bottom line. Most people who think they have SIBO, it's because they have gas and bloating. I think the important point is we have to understand what we're treating. in order to properly treat it.

And I start there. And I don't make assumptions to jump to SIBO very quickly. I do have people that I diagnose with SIBO, but it takes me time to get there because first I want to make sure like the number one cause of gas and bloating is constipation. So I want to make sure they don't have that. I want to make sure that there's not a food intolerance. If they're consuming dairy and artificial sweeteners, I will eliminate those things immediately. They may have a food intolerance like sucrose intolerance.

that's actually there's a breath test for that and if they have that they will have gas and bloating and think they have CBO and then you treat them for the sucrose intolerance and it goes away. So I think the point is let's start with understanding what's causing this. I mentioned earlier that I struggle when I feel that the science is half baked because when I'm standing on very solid footing and I'm ready to defend my position, then you will hear me talking about it. But before I'm ready to defend my position, then that's not a hill that I'm ready to die on yet. And so with CBO, I feel like the data is half baked. And the real reason why

is because the testing, the testing is not where it needs to be. So that breathalyzer test that people talk about with CBO, do you not think that that's a good test? Too many false positives, too many false negatives, both sides. So it's not a good test. And the problem is that that's what we're using not only to diagnose people, but we're also using to do clinical research. search studies with. And if it's not reliable, if it doesn't actually correlate with the gold standard test, then how can we use it? How can we trust it? When you're diagnosing people with CBO in your practice, what are you diagnosing them based on? Is it the absence of positives for other things? Well, I actually will use those tests with the, so this is a complex topic. It's hard for me to do it in two

minutes. But here's what I would say. So my concern with CBO that I mentioned earlier is I think that we are actually causing harm long term by repeatedly reaching for antibiotics. When people take antibiotics and then they relapse and the symptoms come back, then you have not fixed the problem. And repeating that, even if it gives you temporary relief, the reason you have temporary relief is because you are basically suppressing the microbes to the point that they basically don't exist. That's not health.

That's not a healthy microbiome. So my approach is let's work on the, because like most people who have CBO, they actually proved to have constipation. So let's focus on these other things. If it's constipation, let's treat that. And when that person gets into a rhythm and they're pooping, there is no gas and bloating. And there is no longer question of do I have SIBO because they feel normal again. So when you exhaust these possibilities, and it's hard for me to list all of them, but when you exhaust

these possibilities and you have a person, particularly if they have diabetes or they've had surgery on their intestines, CBO is very real possibility for these people. If they've had a ruin why gastric bypass surgery, CBO is definitely a very strong possibility there. And in that case, if I believe that it's there, I will either breath test them or if I'm so wholeheartedly convinced that it's real, I'll just treat them. And I do write prescriptions for antibiotics for CBO. It's just that when I'm treating patients, I'll see hundreds of patients who think they

have Cibow and the number of prescriptions that I write for antibiotics is. five. It's just not a very common thing. That makes sense. And I would encourage people if they're more interested in your sort of thoughts on CBO, you get into that in your new book. And then also, if they're interested in your regimen for constipation, we did a deep dive into constipation in our last interview. So definitely go check that out. You shared a ton of really interesting constipation remedies that I have been using ever since in my own life so I can attest to the fact that they were. I'd love to get into some listener questions. I got so many of them when I asked for people on Instagram to share their questions, but one that I got over and over and over was some version of

like, I'm doing everything right, but I am still constipated. Like I drink enough water. I eat fiber. I exercise. I use magnesium. I take prebiotics. I relax. I do all the things I'm supposed to be doing and I'm still having either bloating or constipation issues. Is there any underlooked cause of those things that we maybe haven't discussed yet? Yes, the pelvic floor. Oh, interesting. Talk to me about that. Okay, this is huge.

People need to understand this. So we have misattributed constipation as being just motility. And there's like this idea that if you just move it forward, then it'll come out. But what if you can't relax your bottom? What if you can't open it up to allow the bowel movement to come out? And these are the people who have pelvic floor issues. And this is far more common among women compared to men. And it can occur, I think, in association, like not literally while you're pregnant, but

like after pregnancy, particularly because pregnancy can often be very traumatizing to the pelvic floor. But nonetheless, this is something that's more common in women. And the key is that if a person has a pelvic floor dysfunction, then you can do everything right, including, like, you can try not just magnesium, but like supercharged medications and still not, still not poop or still be constipated. And the reason why is because what it comes back to is, is if you can't empty, if you can't open the bottom, then it doesn't matter what the motility is. You're running into a brick wall. You have to get the bottom to relax. So the test for pelvic dysfunction, and by the way, who should look out for this?

Who should think, like, you know, maybe I have pelvic dysfunction? This is the person who strains to have a bowel movement, even when it's soft bowel movement. This is the person who goes and feels like they don't completely go. This is the person who has little nuggets for bowel movements, not logs, little nuggets. The person who poops once and then has to poop again 30 minutes later. These are all suggestions of the possibility of pelvic dysfunction. The test that people need to know is called anal-requips. Mnometry. That test will tell you definitively whether or not you have this issue. I see that

doctors are slow to order this test. We would save a lot of suffering in patients if we were quick to order this test because the person who has this problem is not going to be better no matter what medications you try. The therapy, the treatment is to work with a pelvic physical therapist. So just like there are physical therapists who specialize in the shoulder, there are also pelvic, there are also therapists who specialize in pelvic issues. They usually are women because they treat almost exclusively women and includes urinary issues, pain with intercourse, difficulty having a good bowel movement or even incontinence. Next listener question, what are your thoughts on gut cleanses? Is there any validity in wanting to do one? Is there any way to cleanse that you

would recommend? I think that I would caution people against looking for quick fixes and shortcuts and instead focus on creating sustainable small choices that you can be repeated over time and turned into habits. Because then it stops being like a quick little thing that frankly is not making you healthier and then you just get back to whatever it is you're doing. Like instead, let's just create a healthy lifestyle together. Is there anything like does that apply even if you, I don't know, just went on a really indulgent vacation or you just spent all day at Disneyland eating churros?

is there anything that you'd want to do to tip the balance immediately after or is it just going back to your regular healthy lifestyle? It's amazing what a day of clean eating and a good night's rest and maybe some time outdoors can do it for you. It can counter my 14 churros that I go for when I'm at Disneyland. Is it really 14? That's pretty impressive. I want to talk about Disney with you, but we probably need to do that off the air.

Probably offline. Okay, I have a stomach ache right now. What should I do? Where is your stomach ache? where do you feel it? I don't know. It's for my listener. Oh, okay.

It's a listener question. What a question. So it really depends. It depends on where you're feeling the discomfort. And, you know, I think that what this comes back to, one of the things that I'm trying to do with this new book is to empower people to understand their own body and their own symptoms. Because we need to move beyond the sort of paternalistic view of health care where the doctor provides, like, instructions. And then we just mindlessly follow those. instructions and we rely on our doctor to have a complete understanding of our body.

We have to have to have the most complete understanding of our own body and we have to understand what these instructions from the doctor are and why they are and how they're going to affect us. So when it comes to something like this, here's my point. Hard for me to like categorically say do this. It depends on what we're trying to treat. But the question is what are we trying to treat? What is the root of the problem? Let's start there and let's understand that.

then we can move forward with a really like focused treatment strategy. I very rarely get genuinely excited about skincare, but this is one of the most innovative products that I have come across in years and I'm so obsessed with it. I've been telling all of my friends to get it, so now I need to tell you guys. Here's some science first. Your skin isn't just getting older. It's being actively broken down by something called senescent cells. These are cells that have stopped functioning but refused to die. They sit there releasing inflammatory signals, breaking down your collagen, degrading your skin barrier, and accelerating every visible sign of aging.

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It is not masking the signs of aging. It's not targeting one thing. It is actually rolling the clock back at a cellular level. I've been using the face moisturizer for almost six months now and I love it so much. It feels amazing. It goes on really smoothly. It's not tacky at all. And I actually see a difference, which I just feel like is never the case with skincare.

You want to always like see a real difference. And you're kind of like, do I? Do I? And this I genuinely do. Because it's clearing the senescent cells, it doesn't just target one thing. So my skin looks firmer. It looks glowier. The texture feels dramatically smoother.

And I feel like you can see that too. I also love the body moisturizer. It dries down really quickly, which is always a pet peeve of mine. With moisturizers, I hate that like sticky feeling when you go to put your clothes on. This does not do that. But it does moisturize really, really well. And then again, I'm reducing my skin's biological age. I am not making it just look younger.

I am making it actually younger. One Skin has four peer-reviewed clinical studies in over 10,000 five-star reviews. The data backs everything up for a limited time. Get 15% off with code Liz at oneskin.c.co slash Liz. Again, that's 15% off at Oneskin.co with code Liz. Okay, let's just throw out an example. Let's say you ate like a heavier than normal meal and now your stomach hurts. Is there a protocol that we can go for there?

All right. Let's pretend you eat a heavier than normal meal and you're having abdominal discomfort. I think that the first thing that I would do is I would take a break, take it easy. I might drink an herbal tea. So like a chamomile tea or a peppermint tea can be very soothing. If you have nausea, a ginger tea can be very soothing. So, and I would actually rest the gut and give it an opportunity to feel more at ease and comfortable.

Perhaps even a liquid diet for, you know, like doing one meal as a liquid diet is something that could be considered. A liquid diet would look like puread soup or a smoothie or a broth. Yeah, like a broth. You know, yeah, something like that. What about going back to the gut brain axis? My stomach hurts because I'm anxious about a work meat. or something I have coming up in my future.

Is there something I can do to help that type of stomach ache? I think that no, recognizing the connection, anytime we're talking about the gut-brain access, recognizing the connection between both of these parts, they affect one another. So if you do something that has an effect on one but not the other, then we are not completely taking our opportunity to get better. So that being said, like actually diaphragmatic breathing

has been demonstrated to be beneficial in multiple different digestive issues. So actually the person before too, this person and the person before when we revise my recommendations to include diaphragmatic breathing. And it's so simple. You know this Liz. I'm sure your listeners do too. But you just place a hand on your abdomen and a hand on your chest. And you make sure that you're taking deep breaths in for four seconds with your belly being the one that actually moves out as you take a breath in. And then you hold it for two seconds and then you slowly let it out through.

first lips, you frankly can be very loud when you do this. It feels good to do that. Over about four seconds to release it and pause for two seconds and then bring one back in. And you just repeat the cycle and you could do this a series of breaths. And it's actually quite amazing what it can do for our digestion. What is the best time of day to take a probiotic? I think it's before bedtime because one of the concerns we have with many probiotics is that stomach acid can destroy them. So if you take them with a meal or around meal time, then there's going to be higher levels of stomach acid.

So on the flip side, if you eat dinner and then you take a break and then you take a probiotic before bedtime, that probiotic has all night to basically work its magic. How important is buying organic food for my gut health? I've heard there are heavy metals in organic food that could be bad for my gut. We don't have a completely clear picture on this question. And I tend to favor organic for a number of different reasons. Part is my belief that it's better for me in terms of health. part of it is the effect of for the environment and my desire to consume food that's not having a

negative impact on the environment. It's a very privileged thing for me to say. This is not readily available to everyone. Here's the key. Number one, eat plants, regardless of whether they're organic or not. If you can't afford the organic plants or it's not just not within the budget or whatever, that's okay because the plants are still healthy. Like all these studies that show the benefits of a plant-based diet, those are not organic plant-based diets.

Those are people just eating plants. That being said, where do I believe that the value of organic exists? I think my concern is around glyphosate. We have clear data suggesting that glyphosate causes injury to the gut microbes. And you'll find glyphosate in, like, for example, wheat is not genetically modified to tolerate glyphosate, but glyphosate is sprayed onto wheat, unless it's organic, to dry it out. So the advantage of organic is that you know that it was not treated with glyphosate. That's where I see the advantage.

I started adding in veggies and healthy food into my diet and my gut feels worse. What's happening? So this is a common complaint. This is why I wrote the new cookbook because so many people showed up and said, I read fiber fuels, you inspired me. I want to eat what you're saying, but I can't do it. I don't feel well. So we have to overcome those food intolerances.

We have to work through a process to get there. Now, one of the things that may exist is like you could be constipated. And that could be the reason why you feel so unwell when you start adding more of these foods in. And if that's the case, let's treat the constipation first. So I think it's working through a process. In the new book, I actually describe a methodology where I take people step by step. It's called the growth strategy. And I take people step by step through a process where they start at the beginning.

And when they emerge on the other side, they have identified the cause of their food intolerances. and they have taken steps to actually heal and reverse them. And I don't want to take too much time on this, but I just think it's such an important point. We talked about it in the last episode, but you don't believe that when you have a food intolerance, that you necessarily need to be cutting that food out for your whole life, right? First of all, yes.

I do not believe that generally speaking, we should be cutting foods out for the rest of our life. But I think caveats are worthy, given the nuance and complexity of what we're talking about. because people will hear a sound bit and then they'll freak out and then they'll stab me stab me in the throat. So if you have celiac disease, you need to be gluten-free for the rest of your life, non-negotiable. And if you were my patient and you were consuming gluten, you would either stop consuming

gluten or you would stop being my patient because I would stop taking care of you. So like that's an example where very clearly elimination is necessary for human health. I also want to be clear that I don't want people to suffer. So this is not hey, toughen up. This is not, hey, just muscle through it and deal with it. This is instead, let me explain how you can go through a process where you take these foods that you consider to be your enemy and you challenge yourself slowly, incrementally, repeatedly over the course of time.

And those challenges make you stronger. And with each one you are leveling up. and eventually you discover that you have leveled up to the point that this food that you consider to be your enemy is now actually your friend. And not only are you able to find joy in a food that you previously feared, which I personally think should be the goal, not only can you find joy in this food that you used to fear, but actually I've just proven to you that you healed your gut. Because the reason that you were feeling any discomfort in the first place was because of the damage that was to your gut, and we just fixed it. I love that. I think it's such a hugely different approach in your philosophy than a lot of the people

that I hear talk about this stuff. And it feels so much more expansive and optimistic and exciting than this like, oh, you're going to have to live this life of restriction forever. Yeah. And I don't think that that's actually the solution to health. I mean, I'm not just like kind of creating a counterpoint here. I'm speaking what I sincerely believe and see in the medical research. And, you know, I think that we, of the.

Far too often is, I'm quite sure you have opinion on this, I feel that far too often in today's world, we plant a flag, we dig a trench, and we defend the position. That's not what we're supposed to do. Science changes. Science evolves. So instead, what I'm trying to do to the best of my ability, recognizing that I am imperfect and I have my own biases, but to the best of my ability, I'm trying to ride the horse of science and that horse is going to take me wherever the science goes.

I love that. Okay. last three, what is one thing that we can add to our diet every day to improve our bloat? I'm going to go, can I do two? Yes. All right. I'm going to go with Kiwis for one. All right.

So the reason why I'm going with Kiwis is this. When I think about bloating, there are a number of different reasons why a person could bloat. One is damage to their microbiome. One is that they're constipated. And when I think about those particular mechanisms, Kiwis actually address both. We have studies showing that Kiwis are just as good. This may be you.

It's just as good as magnesium. Now you have to eat them routinely, but there's something special about Kiwis that's good for constipation. If the number one cause of gas and bloating that I see is constipation, then I want to address that if you're asking me how to fix bloating. Also, the Kiwis are a great source of fiber and specific unique polyphenols that are great for the gut bugs. So we are healing- Do you have to eat the fuzzy skin?

No, you can peel it. You don't have to eat the fuzzy skin. You can peel it. Although you can, and a lot of people don't know that. Oh, yeah, I do all the time. Yeah, you can just bite the whole thing like an apple, which. Yeah. Yeah.

I quarter it. I will quarter it and then eat it. But yeah, I eat the whole thing. But that's, I won't eat the skin unless it's organic. That's just me. All right. Number two, I would, let me, let's go with fermented food. We talked about it here today.

New study, less than a year old from my friends at Stanford University, professors Christopher Gardner and Justin Sonnenberg and Erica Sonnenberg showing us that in a 10-week study of adding fermented food to their diet, they enhanced the health of their gut microbiome. Why am I choosing this? Because this is mohanging fruit. Most of us are not eating fermented food. So perhaps we should. Do you know what they used in the study?

It was basically wide open. It was basically like, hey, we want you to eat fermented food. So now that included, you know, sourcrow or kimchi, miso, tempe, but not just these things. It also included kombucha. It also included yogurt and kefir. So all of those things are in play in options. So my next one was going to be one thing that we can add to our diet every day to improve our poop. Is there anything different than I assume the fermented food and the kiwi would help with that?

But is there anything else that we could add if we want to get things moving? Well, there's no one who loves talking about poop more than me. And so I let me go slightly different positions. different direction. I'm going to go with chia seeds. I had that in my smoothie this morning. Awesome. So cheese seeds are really cool because they are extraordinarily high in fiber. They're actually extremely high in omega-3 healthy fats. And when you make them wet, they have this incredible capacity for absorbing moisture and going from something that's bone-dry

to like the juiciest, plumpest thing you'll ever come across. And so this is, chia pudding that I'm describing could easily be added to a smoothie. But the point is that when you take a you know, sort of moisturized chia seed, right, you make it moist, then it becomes this like healthy fat, high fiber, high moisture thing that's just going to like slide its way through your gut and carry that bowel movement to glory. It does feel like you're, there's something very visceral about it, like you're pouring Drano into your gut with chia seeds. Like you can kind of picture. it kind of scrubbing the insides of your intestines as it goes down. I mean, I was thinking of something a little bit more friendly than Drano, but yes.

That's right. I picture it like bubbling up and like coming down through my intestines and leaving them like shiny and sparkly and clean. That's violent and terrifying. I feel like I need to put as a caveat, please don't consume Drano just because it's 2022. Please don't drink Drano if you're listening to this podcast. Exactly.

Please consume chia seeds and said, if you were going to leave all of us with just one homework assignment. One little thing that we could start doing today that would improve our gut health, maybe something that we haven't talked about yet. Could you just give us something we could add in? Well, we've talked about some great stuff. And, you know, I can't help but fixate on nutrition because that's what I do and say that I think two key takeaways from today. Number one, plants, eat plants in variety, in abundance. So I'm saying to you, the challenge for the people here, stop counting calories, stop counting grams of fiber, stop worrying about macros, start eating plants and counting how many of them.

And my challenge is for people to increase the variety of plants in their diet. And you can do this by simply hanging a sheet of paper on the refrigerator and pulling your family members in. By the way, kids love this. Kids love destroying their parents in a competition. This is a great way to get kids to eat plants. And so, but like hanging a sheet of paper on the fridge, write people's names, and start recording what plants you're eating or how many different plants at each meal.

And this is a fun way to gamify this process. So there's that. And then we talked about fermented food and how we feel like this new research is very exciting. But if I were to take it in one additional direction, I would say we focus so much on the engineered elements of being a human. nutrition and sleep and exercise. Let's remember that we are a complete person, that we have a soul, we have a spirit, we have experiences that influence who we are, and that in order to be optimally healthy, we need to nurture that whole human being, recognizing that like, we deserve to feel loved,

we deserve to feel supported, we deserve to look in the mirror and like the person that we see. So I just want to remind everyone that like this is a non-negotiable. You deserve that. This needs to be a part of your life. And I and I just, I pray that we all find, because I have not for most of my life actually felt that way, to be honest. So I am blessed that I do now. And I would not be the person that I am without that.

And I pray that all of us find our way into finding that joy. that comes from loving ourselves and feeling love from others and being lifted up together. I love that so much. All right. I'm going to talk all about your book and all of that at the top of the episode. But I would love to hear from you in your own words, all about your new book and also anything else that you have going on that you'd love to share with people. I felt like there was unfinished business with fiber fueled.

And I wanted to create the exciting and beautiful thing about where I am in my career is that I have the ability to write books that can change people's lives. This is not about sales. This is about like people and that dream that I had when I was 16 years old to be a doctor that helps people. Like this is amazing. And so this book is me applying, you know, all of those skills, my experience as a doctor, my education, my background and research.

But adding in that like I'm a real person and I've lived this. myself and trying to create a framework where every single one of us picks up this book and we have our own unique journey. And it is, I would describe it as a recipe based to choose your own adventure for gut health. Let me lay out the tools, right, and put them all on the table. And then you take your starting point and let's take one step. Like, let me walk with you and take one step in the right direction. And then let's continue to repeat that process. And you will build momentum towards health and you will feel stronger and healthier. And you will follow this path that is distinctly yours and different from mine.

And then we will emerge out of the forest and we will have the biggest bonfire and a lot of music and we will dance and have a great time together. And that will be the party at the end of the road. Hopefully out of the literal forest where we're, you know, getting all of the microbes from nature. 110%. So that's that's my elevator pitch. The Fiberfield's Cookbook is your recipe-based, choose your own adventure for better gut health.

I love that. And the recipes look delicious as well. I'm really excited to try them. Well, thank you so much, Dr. B. I'm so excited for everybody to get their hands on your new book and also for everybody to get all of this wonderful information that you have been kind enough to share. Liz, I am grateful for your support. I think you're amazing. You're doing great work.

And it makes me so happy to see all the good things that have been happening in your life. So it's cool. I hope you loved this episode with Dr. B. He has kindly agreed to give away 10 free copies of his new book, the fiber-fueled cookbook, and a grand prize of a free 30-minute virtual session with him where you can get personalized advice on your unique body and gut issues. To enter, just follow both of us on Instagram. I am at Liz Moody and he is at the gut health MD.

And then comment on my most recent Instagram post, whichever one is up there. It doesn't have to be about this episode. something that you loved or learned in this episode. I will DM winners in the next few weeks, but there will be 11 of them, so lots of chances, definitely go and enter. If you're new here, make sure that you're subscribed

so you don't miss out on any upcoming episodes. We have amazing ones coming up, including an episode about how to be happier at work and how to eat for better brain health. So definitely tap that follow or subscribe button so that you do not miss out. And if you love this episode, I would so appreciate you sharing a link on your social media or a link with somebody in your real

life who you think would benefit. There is so much to talk about here. Like, I'm never going to kiss Zach again without thinking about our microbes intermingling. So share it with someone so that you guys can discuss in real life. Also, if you did love the episode, I would so appreciate a quick rating or review on Apple podcast or Spotify. I am so close to my goal of 2,000 reviews and I would be massively grateful for you, taking a little quick moment of your time to write one. It really helps other people find the

podcast and it also makes me feel like I'm not talking into a void, which is nice. Okay, I love you and I will see you next week on the next episode of the Healthier Together podcast. I'm genuinely confused how Masterclass gets literally the absolute top people in every single field to teach every single one of their classes. I use it when I want to learn things directly like the cooking class from Thomas Keller has all of the wisdom that you would normally have to go to culinary school for. But also, I'm being honest, this is like a use case I don't hear a lot of people talking about. I'll just watch it for entertainment when I want to do something that's far more interesting than scrolling. Christina Aguilera taught me to sing.

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