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Heal Your Gut, Heal Your Life | Practical Tips with Dr. Ken Brown

Episode 99, duration 2 hrs 06 mins
Episode 99

Heal Your Gut, Heal Your Life | Practical Tips with Dr. Ken Brown

Dive deep into the fascinating world of gut health with Dr. Ken Brown, a physician and expert in the field.

This episode explores how gut health impacts everything from nutrient absorption to overall well-being and even mental health.

Dr. Brown shares strategies to cultivate a diverse and healthy gut microbiome, the causes and treatment approaches for chronic constipation, including safe and effective laxative use, and the connection between gut health and muscle health.

Ready to take charge of your gut health? Tune in and gain valuable insights from Dr. Ken Brown.

Heal Your Gut, Heal Your Life - Practical Tips with Dr. Ken Brown

In this episode we discuss:
– The critical importance of protein quality
– Impact on more than just muscle health
– Exploring how it influences hunger, brain function, and satiety

00:00:00 – Meet Dr. Jess Gwen: Insights on Dietary Patterns and Muscle Physiology

00:06:26 – The Role of Protein in Appetite Control and Weight Management

00:12:50 – Understanding Protein Quality and Dietary Guidelines

00:19:14 – Essential Amino Acids: Impact on Health and Nutrition Plans

00:26:00 – Optimizing Diets with Essential Amino Acid Density Scores

00:32:51 – Sports Nutrition and Recovery: The Role of Essential Amino Acids

00:39:24 – Challenges of Implementing Protein Recommendations in Practice

00:45:41 – Metabolic Differences Between Animal-Based and Plant-Based Proteins

00:52:30 – Aging, Anabolic Resistance, and Protein Needs

00:59:00 – Research Gaps in Protein Quality and Essential Amino Acid Density

01:05:36 – Protein’s Role in Satiety and Appetite Control

01:12:12 – Future Directions for Nutrition Science and Dietary Guidelines

 

KEN BROWN

Dr. Ken Brown, I’m thrilled to have you on the podcast. Welcome. – Thank you so much, Gabrielle. Love the setup you have here and I’m honored to be here. Thank you. – I wanna tell the listeners something really special about you, okay? And I didn’t share this with you before we sat down because I wanted to save it for the podcast. You and I have been friends now for, gosh, six years? – Yeah, at least. – At least six years.

– I had a friend and she became a patient. She’s a friend and a patient and she was a 34-year-old, extremely well-known entrepreneur.

She went and she did a grail test, also known as the gallery test. And this was before I had helped and stepped in taking over her care. Her grail test came back positive for colon cancer. 34 years old, no family history. And she had also done a prenovos can, the full-body MRI, which showed a mass in her, was it her sebum? – Sebum. – Sebum.

And my heart’s racing a little bit because this is a pretty sad story.

She passed away and I called you when the doctor that was seeing her before said, “Yeah, you came back positive for cancer. Go figure it out. You need to schedule a colonoscopy.” She lived in Dallas at the time. And I called you and I said, “Ken, I need your help. I don’t know what to do. This girl cannot, she’s going to some random colonoscopy place.”

You stepped in.

You did a colonoscopy within the week. You found a large mass in her sebum. You had her scheduled for surgery within the week.

For removal. And I am forever in your debt. I’m so grateful. Thank you. Thank you for doing that. And I hope friends that are listening, you never put in that position where you need to call in a favor. But the way you stepped in and the way you handled it, sadly, she passed away within six months of that diagnosis. She didn’t want to get treatment at the time.

But thank you. Well, thank you for the referral for trusting me. A very difficult case. Completely caught off guard. Really thought that it was going to be something seen, you know, that they were seeing something else on the scan. But that’s what we do. We’re doctors. We treat people. And unfortunately, a lot of people get very frustrated because of the system and the way it’s clogged and the way that insurance companies are involved. And sometimes going peer to peer is the way to make things happen really quick. So it’s, you know, we take care of each other. And that’s unfortunately, people that don’t have access to a friend that’s a doctor or somebody, sometimes they kind of get shuffled around a little bit, but you can cut to the chase. You know how it goes. Yes, I do. And I’ve called you many times.

Fortunately, not as significant as a colon cancer case of a 34 year old, but there has not been one time that you have not come through for me. And I am so fortunate to be your friend. I’m so fortunate to be your colleague. And I just wanted to set the stage so that the listener knows, yeah, we’re gonna talk all about science, but I think even more importantly that they know who you are as a person. – Well, thank you so much. Can I tell you something about you? – Oh, yeah, of course. – So first of all, congratulations on your book. – Thank you, sir. – I have read it. It is great. I love it. I was a little scared when I first walked in here. Let me tell you why. Because I read it, but then I also listened to it on audiobook. – I’m sorry. – No, because once I heard that you were reading your own book, I’m like, okay, well, I gotta listen to this. So I listened to it, but I listened to it at 1.5 speed. – Okay, good. – So when I came in, you sounded like you had a stroke to me because you were talking in my mind. – Yeah, yeah, yeah, yeah, it’s love. – And then I figured something out. If I put you on like two and a half speed and I get on the devil’s tricycle, sounds like you’re yelling at me so I can actually do Tabata’s. – Perfect.

As you write a book and you record your own audiobook, they make you talk really slow. – Oh, do they really? – Oh, yeah. So they slow down your cadence. – How long did it take to record that? – Three days. – That’s it? Just all day, three days? Oh my goodness. – Yeah, it was awesome. It was probably my favorite, one of my favorite parts about actually writing a book. – Yeah, well, you did an amazing job on the audio part. Yeah. – Thank you, sir.

I can’t wait for your book to come out. – Oh. (laughs)

– There’s no writing going on. – The film is bad though. – Yeah, no, no, no. I just, we have a lot going on. I can’t seem to sit down and put any words on paper. – You’re doing very important work. You are a practicing physician. You’re also a developer of a supplement line company. You’re doing a whole bunch of other things. You also have a podcast. You’re also on social media. You have a team. It doesn’t stop for you.

And I have to say, today we’re gonna talk all about gut health and there’s no one that I trust more. You are very well researched and you have a lot of clinical experience and ways of thinking about things. So just at a very high level, let’s for our listeners talk about why gut health isn’t so important. And by the time that they are done listening to this podcast, I think you guys should all grab a chair, you know, saddle in and sit down because we’re gonna talk about irritable bowel. We’re gonna talk about colon cancer. We’re gonna talk about all of the things. This is going to be a mini masterclass. – Oh, geez. – No pressure on gut health. – Something else that you turned me on to after reading your book, I got really excited about the gut muscle access

and how that plays into it. And then you describe in your book about how the muscles are actually an endocrine organ because it goes throughout the whole body. The muscles produce metabolites, which are actually anti-inflammatory and they’re beneficial and they help the brain. The gut does the exact same thing. The microbiome, the 100 trillion bacteria that live in our colon, they produce metabolites. So when you were describing what the muscle is doing, the gut is doing something extremely similar, probably on a little larger scale because it’s a direct one-to-one. And then the influence on the muscles is actually taking place as well. So if you don’t have a healthy gut, we’re gonna go from this, but I just wanna say that for your audience, if you don’t have a healthy gut, you are actually struggling to have healthy muscles or actually maintain muscle. And this gets into all those things you were talking about, the myokines being released. And I mean, that is the language that I talk about. I talk about the metabolites and the cytokines and all that stuff. And this is going on in the muscles as well. And we have the ability to make sure that you can optimize your training regimen by optimizing your gut as well. – I couldn’t agree with you more. And we see that in the athletic population. It’s interesting, as training volume increases,

I have seen a precipitous decline in gastrointestinal health, whether it’s because of permeability, whether it’s because of stress. But the overarching theme is, I think that we could safely say the healthier your gut is, the healthier your muscles will be. It is this full interconnected organ system. We talk about different organ systems in silos, but they’re all connected, especially by myokines, metabolites.

And that is where gut health is,

from my perspective, even the first layer before we even get to muscle health, because of absorption of nutrients, because of the postbiotics, because of the way in which gut health influences everything else.

– Absolutely, I mean, I’m a little bit biased, but– – You don’t say as a practice– – But all health begins and ends in the gut. I mean, when we think about it, we take in the outside world and we bring it into our gut. We have all these influences on our body, but you have total control of what you’re putting in. And what you put in can either benefit your gut or harm your gut. When we’re talking about gut health, I think of it as different places. I think of the direct aspect of, are you causing gut inflammation through various things? Just direct inflammation, poor diet, antibiotics, whatever. And then, are you taking care of your microbiome? So when we talk about gut health, it’s almost easier to start with the microbiome and then work your way up to the pathophysiology or things that can go wrong in the gut, because if you don’t have a healthy microbiome, then you’re kind of starting at a bad spot already. – How diverse is the microbiome? So for example, let’s say you and I have the same diet, how diverse will my microbiome be versus yours? – That is really interesting because there’s other factors that get into play with this. What we do know is that the microbiome can be similar in different regions of the world where the diet is very similar and the lifestyle is similar as well. So like if you go to Sardinia Islands and things like that, where people talk about these blue zones and whatever, the microbiome appears to be somewhat similar, but due to other lifestyle effects, exercise, sleep, if the diet is the same, we think it’s the same, but are you opening a package? Am I actually having whole food plays a big difference? And then how that plays out in relation to the epigenetics, meaning what does your microbiome do for you? What does it do for me? You and I are 99% genetically identical.

We could be 90% different with our microbiome. And what does that mean? – Say that again. So we are 90% identical as humans. – So you and I are 99% identical in our genome. People don’t realize is that the microbiome, the hundred trillion bacteria, thousand species, actually has its own genome. So the genes that they produce are a hundred fold more than what you and I are producing. Two people genetically identical as humans, completely opposite with our microbiomes. They’ve been proven that this is where the whole concept of fecal microbial transplants coming in, how the microbiome right now truly is the new frontier. People talk about it, you hear about it. Everybody’s trying to jump on this bandwagon, but the reality is it really is a new frontier because we have not really figured out how to completely control it. We can test for it. – How long have you been studying the microbiome? – Mm. So I was doing clinical research for 10 full years. So the history of this started when I was doing pharmaceutical research. And it was at that time that the whole concept of bacteria creating some disease, meaning IBS, could be the root cause of all this. And that led to the development of a drug called Xyphaxin. – Which I think is an incredible drug. I’d love to hear your perspective on that eventually. – Yeah, the story behind it is just very interesting because that’s how I started going down the path of developing something natural. Basically, when we were doing the research, they were going for FDA approval on irritable bowel with diarrhea. And irritable bowel syndrome in my world, when I went to medical school in residency, IBS, if you scope somebody and the blood work was normal, it’s in their head.

– I remember something, it was actually considered a disease of hysteria. – Yes, very, very similar to back in the 80s when if somebody got an ulcer, actually prior to that, if somebody got an ulcer, it was believed that you have too much stress in your life. You’re working too hard, you have an ulcer. Then in 82, I believe, discovered that a bacteria was causing it, Helicobacter pylori. That is the same paradigm shift that took place when I was doing research about 12 years ago, where Dr. Mark Pimentel had discovered that something very similar was happening. IBS is not just a functional problem, it’s not just something in your head. The traditional person would just be prescribed

antidepressants, but irritable bowel syndrome is something that can be caused by bacteria growing where it shouldn’t be called small intestinal bacterial overgrowth, certainly in the functional world, they adopted this very quickly. I still have many colleagues that treat people with IBS with antidepressants, that’s it.

While I was talking to him, I was part of the clinical trial setting this off, he said, unfortunately, we’ll never be able to help the bloated, constipated person because what they’re doing is the type of bacteria or the kingdom of bacteria called Arceobacter is producing something, a gas called methane, which is slowing everything down. And then this just leads to a circular problem producing more bacteria, causing more problems. And that’s when I figured out, well, we can, if the pharmaceutical industry doesn’t have anything for it, meaning modern day antibiotics don’t work, let’s look at all natural alternatives. And that’s what I did. At that moment when I was starting to look at this, so this is way before people were really talking about microbiome and manipulating it, the scientists I was talking to, they were already discussing it, especially in Italy and in Spain. And they were saying, well, if you use these certain polyphenols, we know that this is actually what is helping to produce a diverse microbiome, meaning a very healthy microbiome. So it’s 15 years ago when we really started talking about the microbiome back then and how to keep it healthy. That’s the biggest thing. – And we’re still at the beginning, so 15 years into research, from your perspective, we’re still just scratching the surface of the gut microbiome. – 100%, we can test and we can find DNA that gives us clues of what type of bacteria

make up your microbiome. We don’t know if they’re active. We know that we can test for the DNA. Are they alive? Are they doing things? We do know that certain people with certain types of bacteria produce more beneficial metabolites. We know that if you have a narrow microbiome,

which we’re gonna use the term dysbiosis for that.

So the standard American diet’s causing a lot of this. Antibiotics cause a lot of it. But when you have a narrow microbiome, then you lose the ability to produce all these beneficial things. You lose the ability to decrease inflammation. You lose the ability. Equivalent in your book when you have fat infiltrating the muscle, the muscle itself doesn’t have as much ability to produce all those beneficial things. And so when you have this narrow microbiome, we know that this, the best way to think about it is treat your microbiome well, it will treat you well. Keep your microbiome young, it will keep you young. Mistreat it and it becomes almost a parasite. It actually starts hurting you.

And it’s, my son came up with this idea. It’s colon cancer awareness month. And so I give this bracelet to everybody that I scope. And he goes, you know what you should do? – That’s a lot of bracelets you’re giving away. – I know it is.

The, well, they’re little rubber bracelets, nothing fancy. But he came up with this term, which I love. It’s my son’s 19. He goes to University of Texas right now. He’s like, you know what you should do is you should do a play. You should do, you know, the WWJD. Do WWYMS. And so every one of my patients gets this after I scope them. What would your microbiome say?

So that I tell them, so that when you leave here and you’re really hungry and you pull into the Burger King or the McDonald’s or the Whataburger. – Nobody listening does that. – Yes. Look down and go, what would my microbiome say about this? Because it’s that important to keep it healthy. And we don’t think about that. – That, that’s very enlightening. I have a few questions for you. For example, are we born with a certain microbiome? And if so, are some of us born with a more advantageous microbiome?

And what are the things that we can do? If there’s parents listening, what can we do? And maybe it is equal to everybody. The things that you can do like sleep, train, have polyphenols across the board is similar. What would you say the foundational aspects of microbiome health are? – Well, that’s a kind of a two-part question, but that is a great question. We are born and we already start sharing the mother’s microbiome. And we now realize that we thought that the placenta was completely impermeable to other things, but it does– – So you took up before birth. – In fetus, in utero, there is some exchange of developing exposure to the mother’s microbiome. Then the birth process itself, C-section versus vaginal, you’re gonna be exposed to different microbiomes there.

Immediately after birth, all the inoculations, you don’t even realize that your child’s getting these vaccinations or antibiotics and things like that. That being said, a lot of that is out of your control. What is in your control is what we call the golden window. Basically zero to age three or four is the golden window of helping your child have the best microbiome because then it’s set. And if they end up having a really bad microbiome then, then they have to spend years trying to change lifestyle habits, change things so that the microbiome becomes better. So it actually happens really early on as an infant. And that’s something to actually think about. We have to make sure of all the normal daily processes. As an adult, we always talk about sleep, exercise, eating whole foods and things like that. Similar to a child, making sure that they have the best possible diet that is not disrupting it. Making sure that you’re limiting the amount of antibiotics. That’s probably the biggest thing for children. But the highly processed foods is super huge in this.

And all of this plays into the fact that when you have a healthy microbiome, you probably can tolerate a lot more of what life throws at you. You’re getting hit by whatever, pollutants, all these other things, but you could probably tolerate it a lot better when you have a healthy microbiome. If you look at a graph of obesity and adolescence– – I was gonna ask you, that was my next question. – Yeah, and anxiety and even ADHD.

It’s fascinating because it just clips along very steadily. And then right around 1978, you see this obesity line start climbing. And a little bit further than that, like 1982, you start seeing anxiety and ADHD. And if you look, that really does correlate with our change in diet, meaning our change in what is allowable in the diet, high-fructose corn syrup, highly processed seed oils, the flipped ratio of omega-6 to omega-3, emulsifiers. And what we’re learning is when we start looking at this, including artificial sweeteners, a lot of these things actually disrupt. There’s some gut inflammation, like from the emulsifiers and from some of the inflammatory seed oils. But there’s also disruption of the microbiome. – That is really fascinating because what I’m hearing you say is we’ve really honed our attention towards obesity. And we’ve focused on body composition and of course, metabolic dysregulation, the blood markers that go along with that.

And yes, we’ve gotten better at testing for ADHD. And perhaps we’ve gotten more stringent on our screening for depression. But the influence of microbiome is not something that is normally incorporated into that conversation. And so with the increase in processed foods, the disruption of the microbiome, from what I’m hearing you say, probably played and does continue to play a huge role in obesity, in depression, anxiety, ADHD. Is that a fair statement to say? – I think unless you have any other compelling evidence to say this is the exact thing that’s actually happening, it has to be the microbiome. There’s a point in time when we start inducing things into our system that we know are inflammatory. We know that if we’re the only country that sprays glyphosate right before it’s harvested to dry it. We know that glyphosate is a microbiome disruptor. We know that these different things. So we talk about obesity all the time, but it was a flat line until right around that when we started doing all these types of things with the processed foods. And when that started happening, is it the calories in, calories out? I don’t know, your friends with Dr. Lane Norton, he’ll sit there and talk about this. Is it disruption of the microbiome? I don’t know, we’ve got people out there that are doing animal studies, conclusively showing that a lot of this, having a diet, having a standard American diet will definitely disrupt that. Is it the possibility that you’re having intestinal inflammation that actually decreases the enzymes in the gut lining that don’t allow you to convert the amino acids that you’re ingesting into some of the neurotransmitters that you need, dopamine, serotonin, and GABA? We know that if you’ve got an inflamed gut, you won’t be able to do that. Does that lead to ADHD? Does that lead to anxiety? So if you have an inflamed gut, is it possible that you don’t have the right neurotransmitters? Because it’s being, you know, 90% of serotonin is produced in the gut. We know a lot of people don’t realize that GABA, the inhibitory neurotransmitter, the thing that kind of says, whoa, calm down, like the police cop kind of thing, that also needs the gut, and it’s actually converted by the microbiome. So is it possible that we have this huge epidemic of depression and ADHD and anxiety because the foods that we’re eating create localized intestinal inflammation, not allowing these enzymes to work as well to convert tryptophan to serotonin? That’s a possibility. And when the microbiome is healthy, then it’s going to produce these metabolites, short-chain fatty acids, butyrate, things like this, that circulate throughout the whole body and actually heal those cells to allow your body to convert that. So definitely the gut seems to be playing the biggest role in this. I did hear somebody that, I don’t remember who it was, but he was on Huberman discussing how he believes that the reason for obesity is due to a mitochondrial thing. What we’re now talking about is mitochondrial disruption, but that comes back to inflammation. So you can always step your way back to, if we have inflammation,

then this is going to lead to cellular distress. If that happens, mitochondrial dysfunction and so on, is this more than just calories in, calorie out? – Well, I think that we can all agree, many of us can agree that calories in, calories out plays a role, right? This is, there’s probably no denying that. But the nuances of that, I believe are there. I have read some research that talks about this ratio of formicterous and bacteroides, and that some individuals may, and I’m not sure if this is the right word, absorb more calories based on their,

please correct me, based on their gut microbiome profile, whereas you could eat a burger and I could eat a burger, but the impact of that food is going to be different.

Would you say, is that a fair statement? – I think it’s a fair statement. That gets back to what we were talking about, 90% different with our microbiome. And so you and I can eat the same thing, can have something different. A lot of the research that goes on in this is doing this fecal microbial transplant, trying to see if we can manipulate that. They have shown that if you take the stool from a fat mouse, give it to a skinny mouse, and the skinny mouse gets fat, why is that? Well, it has to do something with the microbial genome having an epigenetic effect, turning on different things, changing– – Outside of the gastrointestinal tract, we are talking about a systemic effect, the microbiome– – A systemic effect. – Having a systemic effect on the body. Which leads me back to this question, what can we do? I guess the first part of that question is, how does one know if they have a healthy microbiome?

And what are the pillars that you feel that everybody could deploy upon actions that everyone could take to improve their overall gut microbiome diversity, health, those kinds of things? – So the functional medicine community would say, well, let’s check your stool.

– How effective, and what is the efficacy of these tests?

– I think it’s been best described as we have the ability to test this.

Doing something about it, the science quite isn’t there yet.

And so there’s a lot of companies, there’s so many, in fact, I wrote an article for one of the news outlets about at-home stool testing, this has become a big thing. People can just order it online, they send it in, then they get a report back. Well, what do you do with that? It’s lots of information that’s interpreted, well, maybe you should have more of this supplement, more of this supplement. But the reality is, we don’t really know if changing the ratio of one particular thing. Here’s what we do know, and this is based on human trials.

If you protect your microbiome as much as possible, meaning protect it by getting proper sleep,

trying to avoid stress, avoid antibiotics, and try to eat a diet that is not highly processed, and then you feed your microbiome what it wants. And everybody talks about fiber. Recent study just came out, we’re comparing large complex polyphenols to inulin, which is kind of the gold standard fiber. They actually gave it to humans over a 28-day period, and they did show a slight microbial improvement in 28 days, but these were healthy volunteers to begin with. They all have fairly– – How do they define healthy? – Well, it’s basically based on the ratios. – I see. – When you look at this, it’s the genus, there’s bacteria that we believe that when they are, the ratio is shifted. You will have more inflammatory markers as opposed to non-inflammatory markers. – Can I stop you for a second, just to clarify? Inflammatory markers like HSCRP, are we talking about calprotectin? Are we talking about zonulin? What kind of inflammatory markers are we talking about? – Most of these studies are looking at the cytokines. – Cytokines? – Yeah. – Okay, blood cytokines? – Blood cytokines. – Like interleukin-6? – Exactly, yeah. So like interleukin-6, TNF-alpha, things like that. What they can show is that you’re gonna have higher ratios of that. There’s lots of really cool stuff now where we’re looking in the anti-aging world about keeping your microbiome young and then you can actually stay young because when they look at,

what are they called, superson scenarios, those that make it past 95, I think that’s the term. When they analyze their microbiome, it’s similar to somebody that’s much, much younger. In every other study across the board, from fruit flies to rats to humans, as we age, our microbiome changes and it becomes less diverse. And when I say less diverse, it basically means bad bacteria seem to go higher and good bacteria seem to come down. And which ones are good and bad is kind of irrelevant because we’ve kind of clumped them into these two different things. Certain bacteria produce more of the anti-inflammatory metabolites, other ones actually produce inflammatory metabolites. So we know that as we age, this is going on. Now is it because the microbiome is becoming less diverse and we’re aging quicker? Or through the aging process, we’re not taking care of the microbiome, so it will follow kind of chicken and the egg sort of thing. But knowing that the people that make it to 95 have this very robust, diverse microbiome, we know that that plays a key role and so protecting the microbiome. So feed it what it wants, protect it. And then the lifestyle stuff, the beauty is it’s everything that’s in your book. It’s get good sleep, eat whole foods, get exercise. All of those have been shown to improve microbial diversity.

Your microbiome has its own circadian rhythm. So if you’re disrupting your sleep, like being on call.

And we know that that definitely affects it. We know that there’s, for those people that do shift work, it definitely affects their life expectancy. And it could very well be because it keeps disrupting the microbiome. – We have to reevaluate the way physicians go through training. – Yeah. – I mean, for those listening physicians, depending on your specialty, will be on call every second, third day for 24 hours.

– Yeah, fortunately, I think everybody is at a stage of their life where they can handle it. But if you continue that throughout your career, I think that that’s really where it starts affecting you. – You said something that I just wanna bring attention to. You said protecting your healthy microbiome, which makes me think, I think in terms of muscle and basically in midlife, muscle becomes, you can always build muscle, but really maintaining the health of skeletal muscle is key as we are young and you’re working out and you’re moving and you’re building your tendons and you’re training, the health of skeletal muscle, one would argue hits kind of a pinnacle at 30. And the key is to maintain that strength and power output to avoid this decline. It makes me think the microbiome

is almost a parallel organism or a parallel organ system in and of itself.

How influential can we actually be on the gut microbiome and does one need to, much like the maintenance of skeletal muscle, continue to do those things? So for example, if you were to completely shift your diet and you were to do that for three months,

what kind of influence in a meaningful way, if someone is listening to this and eating a standard American diet or is struggling with obesity or being overweight, what kind of meaningful influence can they have on shifting the microbiome and how long does that last? Or is this such a dynamic process that it is something like your bracelet that one has to do every day? – It’s a very dynamic process and it’s fairly easily done. The problem is that when people on January 1st, I have a whole clinic full of people that come in January 1st and they’re like, “I don’t know what it is. “I’ve turned over new leaf, I quit eating fast food “and I’m eating all whole food.” Many of them are like, “I’m gonna go vegetarian.” And they’ll come in and they’re miserable. And part of the issue is that not only is it the increase in fiber and things like that, but what’s happened is you don’t have the right microbiome to even utilize the nutrients that you’re giving it. And so what I try and tell my patients is think of it that you have to have the right microbiome to unlock the capability of the fuel that you’re giving it. It’s like trying to gas up a Tesla. If you’re giving it the wrong fuel or vice versa, if you pull a big diesel truck up to a Tesla station, you’ve got fuel, wrong microbiome. You might have the right microbiome, but you keep disrupting it with the wrong fuel. So it plays such a big role because once you can get to the point where your body really tolerates it, which is why I think you’re saying, when we talked earlier about how microbiomes can be very regional, because everybody’s microbiome starts to tolerate this recurring diet that isn’t all over the place. Like here, standard American diet, I have a lot of patients that’ll come from wherever. I had an Israeli person that’s like, “This is crazy.” He’s like, “My gut’s all messed up.” He goes, “Everybody at work, they wanna go to have Mexican today, they wanna have Chinese tomorrow, they wanna have whatever.” – Oh, that’s interesting. – Yeah, and he said in Israel, it’s like it’s a very standard version of a few things. It’s more of a Mediterranean style diet. So yes, you definitely can change the microbial profile, but a lot of times people get miserable, miserable. – In the process. – In the process because they’re not ready for it. They jump all in. So it’s kind of an ease in process.

Once you have that, we do know with human studies, within 28 days of taking in, in this particular case, it’s not so much a diet study, but making sure that they’re feeding it specific things like large complex polyphenols. – Which, what would be an example of that? – So an example would be a kibiracho, which is a large tannin. – I don’t even know what that is. – Oh, kibiracho is really one of the world’s, not world, but it’s one of the– – So you’re saying I should know what this is. – No, you shouldn’t because it’s one of the things that I studied way back when. That was one of the few things I found that could actually decrease methane. When I was describing this study earlier with Dr. Pimentel, that’s how I went down that path and discovered that we were using kibiracho Colorado as a food source for cattle to decrease methane production because it was being produced by the same archaic factor that is happening in sebum. – That’s fascinating. – But the study that was done was 28 days, giving healthy individuals two large tannins, kibiracho and chestnut, doing microbial analysis first and then checking it later, and then checking metabolites first and checking it later. So what’s really cool about this is that there was a slight improvement in the microbial diversity, but they were already healthy. So keep that in mind, this was healthy volunteers, but there was an exponential increase in the metabolites. – Which is the metabolites that are, I had a good friend of mine, Suzanne Devkota, do you know Suzanne? She actually is at Cedars-Sinai.

She heads up the Microbiome Institute, which is pretty amazing. And she was talking about that it’s really not about the gut microbiome, the bacteria, it’s about the metabolites that they produce. And it’s about the metabolites that the foods that we eat, like for example, kombucha, it’s not about what’s in the kombucha, it’s about the metabolites in the kombucha or the metabolites that are leveraged by the gut microbiome. – Yes, and so the side note on that, what we don’t know is that can you take these metabolites and will they actually be absorbed or will they be destroyed? That’s one of the questions that are still kind of out there. But it’s the metabolites are everything. And the metabolites are this new place and people are, like all things, somebody will discover something and figure out, oh well, butyrate’s a great example. Oh, butyrate’s good for you. Okay, let’s make a supplement and put butyrate in it. Well, as it turns out, it gets destroyed, it tastes horrible. It doesn’t really bump the actual butyrate and it’s a dynamic thing. But once you start making these changes, you only need a little bit of improvement to actually have these metabolites. And it’s not just those, it’s not just that. So a study was done with one of our PhDs that we work with where she did an in vitro analysis where she put these large same tannins, she did her thesis on tannins in case you wanna hear the same thing. She’s like the world’s biggest expert on this. – And the tannins are the compound that’s in the chestnut or the other– – Chestnut and the cabracho. Tannins, all right, so polyphenols are the molecules that make vegetables and fruits colorful. That’s what gives them their color. That’s what makes the Mediterranean diet healthy for you. What people don’t realize is that polyphenols is just this big umbrella term. And there’s all these different types of polyphenols that fall under that category. It’s almost like having genus and species, but the large ones that are, it starts out as a small phenolic compound.

And then mother nature tacks on a couple more smaller phenolic compounds. And then we have a recognizable molecule. So what she showed is that when the chestnut and the cabracho are metabolized by the microbiome,

she published a paper where she did a mass spec on the various compounds that came out.

And it was fascinating because in there are recognizable polyphenols that people buy, like green tea extract, EGCG. – Yes. – Quercetin, which is there. And catechins and flavonols and all these others. So what’s happening is is that mother nature has this way of putting these molecules together to be larger and larger and larger. So the way that I kind of describe it is you have all these little Lego pieces, and then they’re put together, and you have this big majestic ship or castle or anything that you like building out of Legos. And then those go through your digestive tract,

undigested, and they make it to your microbiome where your microbiome will then break it down. And they just start disassembling these Lego pieces. And it’s these smaller pieces which then can help to break down the different compounds that we’re eating and things like that. Which may be one of the reasons why the diversity, it’s very important, but if you’re feeding it what it wants, then by breaking this down, then you’re gonna get the benefit of all these other things that are going on. It’s these metabolites that are happening. So not all polyphenols are created equal.

So I’ll have patients come in and they’ll be taking five or six things over the counter when if you have the right microbiome, then you can just take a large complex polyphenol. If you don’t have the right microbiome, you’re probably wasting your money.

A lot of different supplements that we talk about, oh, this is a whole separate discussion because I haven’t really been able to figure this one out yet. We know that there’s so many things that are poorly absorbed.

Quercetin, berberine, I mean, you name any one of these things, they’re all poorly absorbed. Everybody’s trying to figure out, we have a highly absorbable version of this. There’s been some recent data about people having these very highly absorbable curcumin, but we’re also seeing in my world liver damage from people taking curcumin supplements. Why is that? It could be that we’re really not supposed to be absorbing these. We’re supposed to be giving them to our microbiome that then breaks it down into the beneficial thing. – That’s a whole– – It’s a whole separate deal because in the supplement world, everybody’s trying to figure out how to make things more absorbable. – And maybe they’re completely missing the mark that it’s not actually the curcumin, it’s the metabolite that the curcumin

produces from the microbiome. Basically, the next advancement in medicine, the way I see it, I’m sure the way that you see it, is that we can actually identify and prescribe certain kind of nutrition plans and certain foods based on an individual’s gut microbiome. Or do you think that that is unnecessary?

– No, I think it would be fantastic if we could sit there and look at this and have an idea of what it is. Maybe one of the reasons why some people just completely love certain diets and they do well with it. – I believe that to be true. – My son said this, he’s like– – Is your son gonna be a gastroenterologist? – No, my son is not gonna be a gastroenterologist. – Astronaut, maybe. – He’s in the College of Engineering right now. He just happens to be a very insightful, good kid, and they’ve watched their dad come home and can’t turn it off ever. – You don’t say, I think that that is something that plagues all of us. – Yeah, so they’ve seen the journey. But he said, “You know, people go around “and they get all these genetic tests “and they wanna know the 23andMe “and Ancestry.com and everything.” He’s like, “Doesn’t it seem more likely “that they should kind of figure out “where their true origin was “and what they ate in that area?”

Meaning that there are very healthy people that they could only eat plants in this area and that’s what they did. Is it possible that they evolved in a way where that is? There’s people over here that really had a higher meat source and they did really well with that.

So is it the microbiome, is it the genetics? Who knows, but it’s kind of interesting. – I frankly agree with you and I’ve thought a lot about it because the thing that divides us more than anything aside from politics is nutrition. – Isn’t it funny? – It is funny. And we have built these concepts based on foundational truths as if everybody is equal. For example, it takes two and a half grams of leucine or 30 grams of dietary protein to stimulate muscle through this mechanism called mTOR. We can safely say that looking at skeletal muscle that this is the trigger point.

Now, the question becomes how come certain nutritional patterns work really well

for many people and I would say probably 90% of the population will do really well with reducing carbohydrates and increasing their fiber and optimizing for dietary protein. But I can’t help but wonder and think about which goes to your point and I have thought about this a lot that there are certain individuals that may do really well being vegetarian or vegan and it completely transforms their life. I believe that it all has to do with the gut microbiome and that there’s early studies that would indicate potentially that the gut microbiome can produce some of these amino acids that are actually essential amino acids that flies in the face of even the term essential amino acids. And that if we can pinpoint who does better, and I guess it’s trial and error, but if we could be more involved in that clinical decision making or help guide people, then I think that the health trajectories would improve. – Yeah, I think it can only improve because we know that these metabolites, well, let’s look at your world. So you’re familiar with myostatin, folistatin. So we know that a metabolite from amino acid tryptophan that isn’t absorbed gets converted to IPA,

which is indol three propionic acid. – Well done, sir. – Thank you. We’re kind of all over the map here. So this is a, I’m stepping on some stuff I haven’t thought about in a long time. So, you know, an IPA has been shown to increase folistatin, which decreases myostatin. So now we’ve got a model of how this could act. So your microbiome can directly affect muscle growth just on that one aspect. We know that butyrate actually decreases the inflammatory response and can sometimes

increase the stem cells with other muscle fibers which are nearby. So there’s like another example. We know that inflammation in itself

makes muscle growth difficult.

So we have all these different things that play into it. So if you can decrease the inflammatory aspect in your entire body, then the gut plays one of the biggest roles to do that. – So you talked about the large polyphenols takes 28 days or so to maybe– – In one study. – One study, but we, I mean, it’s probably, if we were to give a number to think about, like a gut reset, I’ll just throw that out in a silly kind of term, but, you know, a period of time that someone should think about potentially moving the gut microbiome in a meaningful way based on oral intake. I’m not talking about exercise, which probably has immediate, albeit short-lived kind of influences.

The large polyphenols, are there other things that individuals, that you think that all individuals should ingest to improve, and I know we just have to say this cautiously, improve their gut microbiome because again, baseline everything is different for everybody. Are there other foods or things that you think that people should all be using, whether they are fermented foods, and I know this kind of moves us into small intestinal bacteria overgrowth because things like fermented foods might not be good for someone that has small intestinal– – For some people.

What’s interesting about fermented foods that I love, as opposed to just traditional probiotics, where that’s a whole separate hairy world, but the data is pretty soft on whether they’re actually better than placebo long-term, at least in my world. When I go to my studies, when we go to conferences and things, though long-term data shows that probiotics probably are traditional, are probably equivalent to placebo, just straight up, but as I tell all my patients, if you get a benefit from it, then you’re having a benefit from it, and that’s all that matters. But what we do know is that with fermented foods, especially those like kimchi and sauerkraut, we know that the probiotic or the bacteria inside is protected by an insoluble shell, and so I really like those a lot, because now you basically are writing insoluble fiber with fermented food down. Hopefully they’re producing the metabolites like your friend was talking about, and that’s a wonderful, something that we need to get more into to see if we can actually increase the metabolites and so on. But so fermented foods is great, and we know that polyphenols are great, and we know that fiber is great. So any prebiotic, by definition, is wonderful for your microbiome. Doesn’t really matter which one’s better or worse. If you just have– – Fair to say. – If you just have a bunch of it, and if you eat whole foods, you’re gonna get a bunch of it. – Do you care what kind of fiber, whether it is soluble, insoluble, do you have certain favorite foods that you think are valuable for everybody, or is it just based on preference? – I think it’s just based on preference. I think that both insoluble and soluble work together. We do know that they can actually help decrease the glucose spike if you’re having a lot of carbs. That actually helps to prevent your body from reacting to it and producing the insulin. I’m less into nutrition in the sense of, there’s so much noise out there. I like to sort of defer to the dieticians that I work with and let them have longer conversations. Because I’m, the way that I’m, I guess the best I feel, and I’ve tried a bunch of different things, but the best I feel, and looking at the data that I know, I’m like 80% carnivore, 85% carnivore, and I take polyphenols as a supplement. – You do. – Yeah. And so I take polyphenols as a supplement, and I take my fiber, a traditionally soluble fiber, because it’s just easier, insoluble, would just be like the vegetables and stuff.

And my blood work looks great, my HCRP is absolutely nothing. So I mean, at least on paper it looks good, physically I feel good.

Just gotta, Ken will watch the other vice, a little wine. You know, try to keep that back. – Which has, I guess, polyphenols in it. – It does, maybe not a bottle, but you know. – Ken. And by the way, if you guys are listening to this and not looking at it, Ken is jacked. And I think that that’s how we first became part– – I am not jacked. Do not let her oversell this. – I’m not overselling, it is very true. Ken has always been super fit and jacked, and I think I probably ran into you at the gym at an event initially many, many years ago. I wanna talk about this whole idea of irritable bowel syndrome. I actually treat a ton of gastrointestinal challenges in my clinic, whether it is, quote, irritable bowel, whether it is constipation. I do wanna discuss parapsychology, just as kind of a, I wanna mention it, but what percent, your population is skewed. Everyone is coming in with GI issues, but what are some of the top symptoms that people come in and complain about to you? – So let me just basically describe my second opinion patient. So somebody comes to me and they’ve seen several doctors, they’ve had multiple tests,

they have been labeled as having irritable bowel syndrome because that is a trash can diagnosis. The actual Rome criteria that our society uses is you have abdominal pain relieved with defecation lasting longer than three months. If you fall under that category, you’re being labeled as irritable bowel. I’ve always had a problem with that because you can have opposing symptoms. You can have irritable bowel with constipation, or you can have irritable bowel with diarrhea. Now in medicine, we’re always trying to find a unifying diagnosis. – Which is important because we have to be able to, I have to be able to call you up and say, Ken, this person has X, Y, and Z. – Yeah, it’s the old Occam’s razor.

We have this disease, irritable bowel, that affects greater than 20% of the US population. – It’s probably more than that, right? – It’s probably much more than that. 20% that have actually sought care.

And they have opposing symptoms, that’s always bothered me. That’s why it was so exciting when the concept that Dr. Pimitell figured out, which is bacteria causing this, if the bacteria produce hydrogen sulfide, you will have diarrhea. If the bacteria produce methane, you’ll have constipation. That’s an aha moment for me because all these people are coming in. Now, the questions that I ask my patients is, by the way, I know that you have these gut issues. Are you bloated?

All of them, bloated. – Do you care where the bloating is? Is it full belly bloating? Is it below the belly button? Do you care? – A little bit. When we get into the history of it, I care more about the timing. Are you bloated 20 minutes after you eat, 30 minutes after you eat? Are you bloated more when you eat carbohydrates?

Are you bloated in the morning when you wake up? Because the thing is, is that if people feel full, and a lot of times people misinterpret what that word bloating is because it means different things to different people. But if somebody wakes up and they’re completely bloated and the bloating never goes away,

typically that is more of a functional constipation thing. That’s more of that. But if somebody wakes up flat, eats a carbohydrate-rich meal, and then they blow up, well then that tells me that this is the person that has been labeled as having irritable bowel syndrome. The problem is, is that they go in, they get told that they have IBS. They wake up in recovery at an endoscopy center and they say, “Great news, Gabrielle. “Colin was perfect, endoscopy was perfect. “You just have IBS.”

You get up and you walk out and you go,

“I still don’t feel good. “I still have bloating.” Then I ask the question, “Do you have brain fog? “Do you have fatigue? “Are you in trouble sleeping?” Because all these things play into it and then that tells me more that there’s more going on. What I want to change the paradigm shift in this thing is, is that bloating is so pervasive that it is considered normal.

I mean, literally it’s like, well, everybody bloats, right?

Well– – Not Matthew. – No, Matthew. – My producer, never.

But I kind of think of bloating as the canary in the mine shaft. That’s the first warning sign that your gut is unhappy because you’re not able to tolerate the foods that you’re giving it. Whether the timing of it 30 minutes or it’s several hours and I’ll get really bloating, super gassy, and that tells me your microbiome probably is not ready to handle the food that you’re giving it. Either way, what we’re talking about is an unhealthy gut or the beginnings of an unhealthy gut. And we know that if you let that go on,

then in the lining of the intestines, you have very, very tight junctions. And the purpose of this is to take in the outside world selectively and make sure that you defend yourself also if it’s something that’s there. And we call that the tight junction. Over time, the bloating is a signal that this is early inflammatory process in the gut. And when this takes place, then you start developing more of a porous gut, leaky gut and functional terms, intestinal permeability if we’re talking to a medical doctor. It’s funny how I use different words depending who I’m talking to. So bloating is the most common symptom. And if you have bloating, that’s the canary in the mind shaft because now we’re starting to look at all these people that have end stage diseases and we’re doing retrospective analysis on them and going, oh, well, wait a minute.

Your husband had dementia, your husband has severe dementia.

Did he ever have any gut issues? You know what? 20 years ago, he really started complaining about his gut. And it just never went away.

And so that’s why I’m saying that the incidence of autoimmune disease, the incidence of cancer, the incidence of all these things continue to rise. Why is that? I mean, we have the generation, which is dying younger than the generation before. Very weird. What’s going on? Well, what could be going on is that we’ve allowed the warning sign to become normal. So bloating is number one. Bloating is by far number one. Bloating is the most common symptom any gastroenterologist will see and it’s not– Not constipation. Well, the people will always start with the bloating. So constipation is super, super common, but the symptom is I feel bloated because you can be constipated on paper. In other words, you may not have a bowel movement for four days, but if that’s your norm, then– You don’t consider yourself constipated. You don’t consider yourself constipated. You could be bloated one day and not have gone to the bathroom

and you consider yourself constipated. So it’s the perception of whatever your normal is. But the point is that the most common symptom is bloating and it’s not even included in any of the diagnostic criteria for irritable bowel syndrome, which is super weird. That is weird. And what would be, once someone talks about bloating, are you immediately then thinking, what is the next step? Are you thinking, okay, well, let me see how advanced the– I hate to use the word disease, but how advanced is the disease? Do we need to start looking at zonulin and calprotectin? Or is, what is the first step after someone comes in and says, Dr. Brown, I’m bloated? – Hate to be really boring about this, but the history. History, give me a history. What happens when somebody comes in and they’re like, you know, I’ve had diarrhea. I’m like, do you get bloated after you eat? I do, I guess I’m a little more gassy. Yeah, when were you last normal? What do you mean? I’m like, when do you last recall not having issues? It’s like, oh, it’s funny you bring that up. It was– – After I got food poisoning. – Yeah, it’s right before I had my honeymoon. And then it’s, I had my honeymoon and I got sick. We were in the Dominican Republic and I’ve never been right since. And that is, so a history of that. Now I’m making a sharp turn towards, okay, let’s worry about bacterial overgrowth. Somebody that has said, I’ve had absolute issues my entire life and do you wake up bloated? Yes. Do you feel like you can go to the bathroom? No. Do you spend a lot of time on the toilet? Whatever. Then we start talking about childhood. If they’ve had stuff for a long time. Oh, now we’re dealing with functional constipation, possibly pelvic floor issues. – Okay. – And then you start going down that route. And so everything in the history to me just sort of dictates what the next test is gonna be. – Let’s talk about small intestinal bacteria overgrowth because it is so pervasive. And when I was looking at some of Pibntale’s research and some of the research, he really pointed out that something happens that, and you and I were talking previously, right before we started recording that one in nine people that get food poisoning, whether it’s campylobacter, or I think that there are three other main bacteria that cause food poisoning,

those individuals, one in nine, and I think it’s higher. You had mentioned that it’s higher. – Yeah, I think it’s significantly higher than that. – We’ll get small intestinal bacteria overgrowth. And if that is left untreated, then it becomes an autoimmune disease.

– If it’s left untreated, then that intestinal permeability allows your, you have a garter cell called a dendrite, which reaches up, grabs samples the outside world. If it happens to sample the shell of a bacteria, lipopolysaccharide, called LPS, then it hands it to a B cell. That B cell goes, well, that shouldn’t be there. Let’s call the troops in. And then they call the troops in, turn on the inflammatory cascade cytokines,

recruit more white blood cells. And now we’ve got our immune system, which is turned on, but it’s not really fighting anything. Meaning it’s not really, you can’t go into the lumen and get rid of the bacteria, but the bacteria is constantly pinging the immune system. Well, people that are genetically predisposed, that heightened immune system eventually will find its way to the thing that causes RA or celiac disease or Crohn’s or ulcerative colitis. So the model of autoimmune– – What about Hashimoto’s? – 100%. – Okay. – 100%. – I wanna pause here because this is really important. We’re talking about gut health. We’re talking about small intestinal bacteria overgrowth. We’re talking about the triggering effect of a bacteria like food poisoning. And it sounds like it could really be anything. It could be any kind of gut dysbiosis, but we could just pinpoint that something happens that creates this insult in the gut. And then it triggers the rest of the body to have a flare up of whatever that person is genetically predisposed to, whether it is Crohn’s or Hashimoto’s, which is thyroid or rheumatoid arthritis, that the canary in the coal mine or the linchpin is really the insult to the gut. – Yeah, so over time, we think that’s one model to which can lead to autoimmune disease, probably leads to all kinds of other diseases. – Yes, sir. – Because it’s inflammation. But we come back to the same thing. The other thing is when we’re talking about sampling the outside world, the cells that they get turned on, once it hits a mass cell, one of the white blood cells that can release histamine and different other things, it can actually touch the enteric nerve, which goes directly to the central nervous system, which is why many people have brain fog, fatigue, things like this, anxiety, when their gut isn’t right, because there’s a direct connection. More so the indirect is through the vagus nerve, but we’re talking a direct connection, cell to cell, it goes all the way up, and you can have this brain-gut connection going on. And so that’s possibly contributing to the dementia later in life, but it’s all tied in, which is what we’re just learning. The more and more we learn about it, the more that it’s all interconnected.

– And do you test for small intestinal bacteria overgrowth? I do wanna hit this because there are tests like anti-viculant tests, and this idea that then shows that there’s this autoimmune component directly in the gut that then can cause chronic constipation if small intestinal bacteria overgrowth gets out of hand and then causes this autoimmune response, ultimately affecting these viculant, right, so viculant, you should probably explain it better than I do. – Yeah, the anti-viculant antibody is what they’re testing.

– Because that is, as I understand it, part of the motor units in the gut that helps with mortality.

– So when we talk about SIBO, we’re really talking about a motility issue. What’s going on that allows this bacteria to keep growing? Why can somebody show up with years of this problem? The model is that some insult happens. Dr. Pimentel’s research in the lab that he has, they’re really looking at them, and he’s very academic, which I love, so it’s you need a breath test, you need to check this blood work. – The SIBO breath test. – The SIBO breath test, the Trio Breath Smart is his particular one that he’s involved with that company. And you need to check everybody for these autoimmune panels. What ends up happening is, is that when your body fights an infection like Campylobacter, the antibodies produced to kill Campylobacter happen to be very similar, or the antibody happens to fit. It’s like a lock and key mechanism. It happens to fit very nicely on vinculin, so it’s an anti-vinculin antibody, and it makes the vinculin not work. This is the equivalent of having two telephone poles, and you’re supposed to conduct an electrical current between the two, but you shut off one, so the current goes here and then just stops. And now there’s no current to the next one, and there has to be an alternate route to keep that going. In that area where it’s shut off because of the anti-vinculin antibodies, then bacteria can start to grow, and that’s the model of having recurrent bacterial overgrowth, which is very hard to get rid of. So I don’t always do that. I get people that have already spent a lot of money, and I like to just get the history.

I’m less academic and purely clinical in this setting, where somebody’s paying their money to come to me. I like to treat them, and so I will treat frequently if the history is right. I don’t care what the breath test shows, and there’s other– – What will you treat with?

– Depends on if they have constipation or diarrhea. – Let’s talk about it. – Well, so we talk about polyphenols, and so the polyphenols is my world, the complex polyphenols, and so I developed a product specifically for this, so we always use that. – And that’s atrantial? – It’s called atrantial, and so I always use atrantial. – And how do you dose that? – Two capsules, three times a day for a minimum of 30 days, that whole thing of time. It takes time. – It does. – And the reason why we talk about the microbiome is one of the things that intrigued me was some people that take it, they get worse before they get better. We thought it was always die-off, die-off meaning that, oh, it’s because we’re killing these archaeobacter, and they’re releasing their– – Their last moment in their life. – Yeah, their last moment, and it’s irritating, and it gives you flu-like symptoms, but now I’m actually thinking it probably has more to do with the inability to break down these large complex polyphenols because your microbiome isn’t right.

When I did my initial study, so we did clinical trials on this, randomized trials,

people that didn’t respond, some of them were coming back in and they’re still on it. I’m like, I thought it didn’t work. They’re like, I know, but I kept taking it, and some of it’s weird. It’s just, I’m just feeling better now, and it took me a long time to figure out they’re probably adapting to the ability to get the most out of it, meaning that it’s not absorbed, so you need the microbiome there. So I use atrantial.

Almost always we’ll use xiphaxin as a prescription. – Can we talk about that?

Xiphaxin is a medication that is FDA approved for small intestinal bacterial overgrowth. – FDA approved for irritable bowel with diarrhea. And I’ll– – Go ahead, irritable bowel with diarrhea. – So the reason why I say that is, is that it’s irritable bowel with diarrhea because if you put– – AKA. – Yeah, if you put SIBO, which is a code, the insurance will deny it.

So it’s very funny that I’m like, listen, we all know that this is the same thing. IBS with diarrhea being treated with xiphaxin. So it’s xiphaxin 550 three times a day.

And Dr. Pimentel’s studies were always two weeks. I do a full, or I do a full 28 days. – Yes, same, I do too. – With one refill.

– So you do 28, or do you do two weeks with one refill, or do you do 28 days with one refill? – What the insurance will allow me to do. So I think I can only get 42 tablets at a time. It’s all just trying to play games because it’s absurdly expensive if you can’t get insurance to pay for it. – Couple thousand dollars. – Just nuts.

So I do xiphaxin, and if there’s constipation with it, sometimes I’ll add neomycin, and I dose it 500 three times a day.

You’ll see that the prescribing dosing is 500 BID.

– And you use, so you use the neomycin three times a day with the xiphaxin. – With the xiphaxin. And these are people that have come that have failed a bunch of things. So I’m throwing the, this is my kitchen sink regimen. – I’ll take the kitchen sink regimen. – And then we gotta do something for the motility at night. So when we’re talking about that motility, what ends up happening is when that vinculin antibody binds to the electrical pole, telephone pole, whatever you wanna call it,

at night when we go to sleep, another reason to make sure that you have deep restful sleep is that every 90 minutes, something called the migrating motor complex, or the housekeeper phenomenon takes place. So every 90 minutes while you’re asleep, a large electrical impulse starts in the stomach and sweeps through your whole small bowel and dumps everything into the colon. And that is the housekeeper phenomenon, which is what it’s called. – I just learned I have never heard of that before. – Really? – No. This is probably the key to getting people fixed because you treat them during the day, then they go to bed. And if you don’t have that swooshing of getting rid of it, if you don’t let the housekeeper come in and sweep up the small intestine,

the bacteria that remain just regrow.

So the key here is to do a motility agent while they sleep. And we’re kind of limited on these is the problem.

– So does low dose naltrexone fall into that? What kind of, or is that a low dose erythromycin? What are you using for motility agents? And why are we limited? – I have not, I tried to find the data on LDN specifically for gastric emptying and specifically related to the migrating motor complex. It’s a little hard to find hard science on LDN regarding that kind of thing. Have you had an LDN expert on your show? – I haven’t. I need to get somebody who really knows it to try and talk about that. – Yeah, we probably have to get a pharmacist who did clinical research. I’ll look.

– Oh, I’m supposed to have somebody on our show and they live here in Houston. – Great. – I forgot about that. – I’ll interview them first, all camera on. Let me see if they’re good. – I’m a little bit selfish sometimes on our podcast because I like to bring people on that I can learn something from. – I always bring people on. That’s why you podcast. – Listeners and watchers and viewers and friends, you guys think that I’m doing this for you. Well, I am, but I always bring guests that I feel I can learn from and that they can learn from. Isn’t that why we have the podcast? – Yeah, and find topics where people can cover stuff like that, but you brought up LDN. So no, I’m not using LDN for that. I have used some erythromycin,

but right now the thing that seems to be working pretty well is motegrity, which is percaliprides. – Yeah, but yes, motegrity always is used that at night. That does not affect the serotonin system. – So it turns out that it does because there’s some side effects that people have from it. – That are. – Yeah, like mood dysregulation and things like that. But it stimulates the 5HT4 serotonin receptor, which is what we’re trying to go for. So it’s percalipride, really low dose. I have one milligram trying to add that at night. Now this is the kitchen sink, and the kitchen sink never gets paid for for me. So I can never get all this. – Let me ask you this. – It’s always a version of it. – Could we potentially use this? And I’m talking colleague to colleague. Could we potentially use something like magnesium citrate? Because it’s just that we want, is it that we want the peristalsis, the para, you’ll say it for me, – The peristalsis? – Yes, wave, or could we, or we’re just trying to move things through. So we could potentially, I hate to say give them a little diarrhea, but maybe increase magnesium citrate to have them go to the bathroom at night or even magnesium oxide as a motility agent. – So my experience is those are always modic agents, meaning they’re hyper concentrated. So magnesium oxide, magnesium citrate, they draw water in. It’s the drawing of the water in that goes through. You may get a little bit of a contraction, but the reality is that the liquid itself will make its way through without having this large sweeping wave. And what I mean by the migrating motor complex is if you look at a manometry, meaning the muscular contraction, it is a wave that travels down. And so it is an actual ringing of your intestines. And so it’s definitely something about the contractions, probably related to cell turnover, probably related to increased blood flow, all those things in the small bowel. The magnesium citrate and oxide are really good osmotic laxatives. When it gets to the colon, it draws water in. When the water is drawn into the colon,

if it gets stretched a little bit, the reflex of the colon is to contract, which is how fiber works, it stretches the colon a little bit, and then it basically contracts and keeps everything moving. The problem with those is that if you are already somebody that feels quite bloated, you can actually add quite a bit of fluid. That’s where MiraLax also makes my patients feel pretty miserable. Because are you having a bowel movement? Yeah, okay, good, and then they stop at that. – Okay. – Or the doctor stops them, great, you have a bowel movement. – See you later. – Yeah, but they’re still kind of miserable.

– So do you test for small intestinal bacteria overgrowth, or do you say, okay, basically, I don’t need to test, but if you have bloating and diarrhea, you have small intestinal bacteria overgrowth, we are gonna treat you with Xyphaxin and Neomycin. – This is assuming somebody’s come as a second opinion, and I can make sure that they don’t have something else. – Okay. – Yeah, because there’s always, I mean, there’s always– – Like we can even endometriosis or something else. – Yeah, well, not even that, but like in my world, they’ll come as a second opinion for a gastroenterologist, so I at least know that they don’t have Crohn’s, ulcerative colitis, celiac disease, to make sure we’re not missing some underlying cause. – Some underlying stuff. But I guess selfishly, I’m asking this question because I always do a breath test because I, because there’s also, there’s methane.

Give me the three. – Hydrogen, sulfide, and hydrogen. – And hydrogen, and then there can be a mix, right?

How do you treat each one of those? – So the beauty of the hydrogen sulfide one is they’ve, they being Pimenton and company, they’ve isolated the type of, I think it’s an E. coli that actually produces that, but the hydrogen sulfide are sulfide-reducing bacteria. There’s just a lot of them. It’s easier to treat. So those get treated with xiphaxin, and I mean, the same regimen’s gonna be there. – And do they have diarrhea or constipation? – Typically they will have diarrhea.

The true hydrogen sulfide people. And then it all comes down to hydrogen being produced. So you have bacteria that break down the food before you can, they release hydrogen. If you have archaeobacter, on one side, the archaeobacter says, you know what, I like that. It grabs the hydrogen, it grabs four of them through an enzymatic process, produces methane. Other bacteria are like, you know what, I like that. I just need a couple hydrogen over here, and they’ll produce hydrogen sulfide. Problem with the breath test that I run into is that when I have a good history, I’m like, let’s try treating so we don’t have to worry about this. The breath test can be really variable, and we’re learning this. – I see that all the time. – Yeah, and we’re learning more and more because there’s something called a food marvel. Have you heard of this? – I haven’t. I’m learning something else. – So it’s a company out of Ireland that we’ve been doing some work with, and they’re actually doing their own study on us. But it’s a pocket breath test. It started out to figure out what foods you would have food intolerances to, and then they quickly realized it may not just be food intolerance, it could be bacterial overgrowth, and so what foods are triggering more of the gases? And so you eat, and then you blow into it, goes up to the cloud, and it shows what gas you’re actually producing. Right now it cannot find hydrogen sulfide, but it can do hydrogen and methane. But what we’re seeing with this is we’ve got people that those food marvels respond to certain things, and then it’ll change within 12 hours. And so is the breath test kind of a snapshot? Is it done the exact same way every single time? Is it possible that there’s variables? I only say this because I still use lots of breath tests, but I like to use it to either guide me one way or the other, like is this really, are we just barking up the wrong tree here? Or why aren’t you responding? And here’s an example that I’ve learned with breath tests. So I’ve had people that have come in, and they’re just classic. It’s like there’s just no way you’re not gonna get better.

Great historians, they wanna get better, it’s things. I only say that because as you know, there are patients that have identified with their disease so long that it’s like, I don’t know if I’ll ever get you better no matter what, but you’re not sick, that’s the important thing. But I’ve seen certain cases, and I actually was on a webinar with Dr. Pimentel, and I brought this up, and he’s like, no, I’ve never heard of that. I’m like, okay. But I’ve seen the breath test spike very early.

So we’re talking 15 minutes into this thing, very early, and then come down.

Everything we’re giving them probably hasn’t even– – Hit. – Hit yet. Or it’s hit and gone through, but hasn’t opened up yet.

So we’ve got xyphaxin, which is still in its compressed little tablet that isn’t dissolved yet, and so we’re missing it. So these people, just everything we’re giving them. And so I’ve had good success by changing that, breaking tablets, doing stuff. Let’s get the medication available to the early part of the duodenum where you’re growing all this stuff based on your breath test. Or opposite, you have a very high spike late, so you’re somewhere in the distal small bowel. I wanna go up on the dose of everything because we need to get more concentrations to get there because by the time it gets there, it’s diluted a little bit. So I use breath tests a lot for that. I use breath tests a lot for trying to

see if the correlation of the symptoms correlates with the breath test. If there is, then we do a food marble. I might take this home, let’s see if we can find a pattern with this. So I don’t do that with everybody. A lot of the other people in the SIBO world definitely do. They say you have to get a breath test, you have to do this. But I’d rather– – When do you decide to add in neomycin? Is that the only other additional medication that you’ll use? So xyphaxin, which we should say, is a really, I might be partial, but it’s a really amazing antibiotic. It seems if what I read is correct and maybe something new hasn’t come out since I read it, but it stays in the gut. It is not a essentially systemic antibiotic. It stays in the gut. It can help with almost resetting the, I don’t wanna say gut microbiome, but– – Yeah, it definitely does not affect the gut microbiome adversely or beneficial. We’ve known that actually, we were trying to look at different things for treating ulcerative colitis with it. So the key to treatment for SIBO is intraluminal delivery.

Intraluminal delivery, meaning it poorly absorbed things are the things that are gonna help, which is why traditional antibiotics that get absorbed, you may get some benefit in the small bowel for some of it, but you’re absorbing them, which ultimately is gonna disrupt your microbiome. So we get really cautious about throwing antibiotics at people and hoping that it’ll make the bacteria go away. The large polyphenols are unabsorbed as well. So that’s the whole concept of why that’s there. The kibiracho itself has all these hydroxyl bonds on the outside and it works like a hydrogen sink. And it’s one of the few plants that can actually damage the archaeobacter or the methane producing type of bacteria.

The funny thing about ziphaxin is that

when we did the studies with them, so we were, me and my research manager, were one office in a suburb of Dallas

and the other sites that were enrolled, Cedar Sinai, Mount Sinai, Johns Hopkins, Mayo, just all the usual heavy hitters, they were all enrolling. And as it turned out, we were the leading enrolling site in the whole country,

not because of bragging rights, because I didn’t know well enough because an FDA agent showed up at my office. – Not because of, whoops. – Yes, whoops. Don’t be a brand new researcher and be the leading enrolling site. But what was really interesting about it is that that definitely shows the difference between academic center where you have fellows recruiting and the number of people, and just sheer volume of a traditional community practice.

But what was wild is my results were way better, and I was part of the clinical trial, so I’m randomized, I don’t know what’s going on, but when they uncovered it, my results were way better than what they actually ended up publishing with accumulative data. And in total, it was like six, nine percent better than placebo. My results are way better than that. And I think it comes down to choosing the right person, talking about it, and most important, compliance. The compliance of taking it for that full, and the study was only 14 days, but taking at least three times a day, 14 days, with the xiphaxin, very few side effects. Outside of cost, that’s the only problem with it, is basically the cost.

– And we’ve got other treatments, so we’ve got xiphaxin, neomycin. – The reason why the neomycin is there is because

the xiphaxin really does not work against this archaeobacter. Neomycin has a little bit of effect against it. And so a couple studies came out which showed some benefit taking both of them to help with constipation and methane production. – Any other medications used for the treatment of SIBO? – Oh boy.

Yes, I use a lot of different things. – And do you use a lot of different things? – And I think that one of the reasons is I’m diving so deep into SIBO is because I think that all of us, either clinicians or people listening either have it or haven’t countered it. Again, it’s this bloating, it’s this diarrhea or constipation, I mean, it seems as if it is going to affect all of us in some way or another, whether we have it or a patient or a client. And we have to really get clear that there is some good science behind it about what potentially it could be and there’s some really good potential treatments. And it’s really important to treat because if left unchecked, once an individual gets damaged to these viculin or kind of these motor units, I think it’s very difficult to fix chronic constipation. And it seems to affect autoimmunity and inflammation as a lifelong problem. – Yeah, for sure. And I think that that’s why it’s so important for me to sit there and say, we don’t always have to put them in this perfect box. I don’t always need this antibody blood test. I don’t always need this breath test. What I need is for your gut to heal. How we do it, well, let’s try some different things. We’re gonna definitely go down. If you have the history and you sound like SIBO, we definitely need to do that. But the beauty of using some natural products is that even if you’re not getting rid of what you think is the SIBO, you’re at least helping the microbiome, for instance. There’s other things that are going on that we’ve been doing. I came out for my patients. I have what I call a SIBO support box, which is AM and PM packets. We teamed up with Zymage entities. – I didn’t get one, this is ridiculous. – It’s because I traveled here. I had to travel light. I flew to Houston for this. – Well worth your time, my friend. – Totally worth my time. Because what I was seeing is all these people were coming to me and they were having food intolerances. They’re like, I can’t eat this, I can’t eat that, I can’t eat this. – Which would you say that that’s part of that FODMAP diet? – So the FODMAP diet is just low in these fermentable sugars. And I’m not a fan of that because if you’re on it long enough, you become micronutrient deficient. And it’s kind of a band-aid. And the FODMAP diet just took off because it’s got a cool acronym. And so people start throwing that on. – Debatable. – You know, whatever.

But after listening, people were having all these food intolerances that they didn’t have before. And then you start looking into it. And then let’s get back to where I was talking about the enzymes that break down those amino acids. Well, we have other enzymes, like something that breaks down histamine, diamine oxidase. If you have inflammation in the gut, the diamine oxidase can’t work as well. And it actually is not able to produce enough diamine oxidase. Then when you eat anything with histamine in it, like an avocado, avocados sound safe, spinach. – They feel terrible. These people feel terrible. – They feel terrible. And one of the reasons is because the histamine that’s being produced gets absorbed. And then the histamine is creating this sort of systemic reaction. So I’ll use, in this box, with everything that we’ve talked about, I’ll use diamine oxidase.

I have atranteal in it, AMP in packets. I put immunoglobulin Y.

You’re familiar with colostrum and things like that. Colostrum, one of the main reasons why people use it is for the immunoglobulin, IgG. IgY has actually been shown in studies to be more stable throughout the gastrointestinal tract. So this way it can go through the whole length of the small bowel. So I add the IgY.

And then in the evening packet, I add a combination, highly absorbable magnesium. Because as it turns out, when you have bacterial overgrowth, the inflammation in the gut and the bacteria can actually deplete your body of magnesium. So we– – And why is that? Do we know? – It’s just because the organisms themselves will use the magnesium that you’re taking in. – So selfish. – I know, and so.

And the beauty of using magnesium, glistenate, and magnesium malate is that malate has been shown to improve intestinal motility, like we’re talking about. And then glistenate has been shown to help with anxiety. – Yeah, it’s really, really interesting.

I think that that’s helpful for people.

Is there anything more that you wanted to cover on SIBO? Because I have one more question regarding SIBO. And that’s this idea that it just seems that it’s almost refractory sometimes. That they do really, really well on a combination of Xyphaxim. They, you know, you put them, they can go back to eating normal foods. They don’t have to follow this FODMAP diet. They’ll be fine for a couple months, and then it’s back.

– The unfortunate thing is what we have also seen is that Xyphaxim can work great once, pretty good the second time, and not work the third time. So there is some sort of tolerance to that.

I think that the key to these people that have this refractory situation is to work downstream and improve the microbiome so that the microbiome can correct the problems going on. So if you are producing pro-motility metabolites like butyrate, then you’re gonna correct that motility issue that’s allowing the bacteria to grow every night. So over time, I’ll have people that just seem impossible to treat, impossible to treat, and we just try all these different things. And let’s try this, let’s try that. And then just over time, all of a sudden, it just gets better. And I think it all comes down to the SIBO in the small bowel is affecting your microbiome causing dysbiosis. And as long as you’re having dysbiosis, then the two will go hand in hand. And so if you can’t totally get rid of the SIBO, then let’s at least focus on the microbiome. And over time, it seems to work. – So this is just a long game, is what you’re saying, is with the small intestinal bacteria, overgrowth is, you can treat the small intestinal bacteria, overgrowth, but you want to create an environment where gastrointestinal health permeates, no pun intended. That’s is really kind of everywhere. – Yeah, but I don’t, I mean, I hear this from a lot of people, well, it just seems to never go, I don’t have that many patients where they come in, they’re like, nope, didn’t work. I mean, maybe three or four, and I still see them regularly because we’re trying everything. – Yeah, I have one patient, but then again, she hasn’t been great about doing her test because I did, she does have animals, she has a handful of dogs, and I think that there may be a Giardia component to that. I think that there’s a component to parasitology, which before COVID, we would send everyone to a parasitologist to do a stool sample, and they looked it under the microscope, and now everything is done with DNA testing and PCR. It seems to miss these, and we see this with the military, it’s a huge game with the special operators because they go to all these different places. I had one guy come back in his entire platoon, actually had their gallbladder out. They all got sick. – Wow. – Yeah, all of them.

A platoon, and they all have SIBO, everybody has SIBO, but they also have a handful of, whether it’s roundworm or whipworm or Giardia or and amoeba histolytica, and it seems as if they pass it back and forth because of toilets or things of that nature. Do you find that, do you feel like the parasitology testing is adequate that we’re doing now? Are there any opportunities for improvement that you’ve seen, and this might not be your domain, but I’m curious. – It’s definitely not my domain, but I will say I think that we don’t have good testing. – We don’t. – And so, especially if I’m using labs that are required by the insurance, the duopoly of LabCorp or Quest, – Yeah, yeah, yeah. – They don’t, it’s crap analysis. I do do, I’m using a stool test called Genesis stool test, which does use some DNA analysis and things like that, but it’s still like, it’s always, it’s not good. It’s always negative. – Yes, it’s always negative, and that’s because whether the burden is high enough,

yeah, we still send out to infectious disease.

– Our infectious, we have great infectious disease doctors. Our infectious disease people don’t believe that there’s a whole lot of parasitic involvement causing disease in the area that we live in, and so it’s– – It’s not true. We get food globally, they are an animal. I mean, again, the reason I became very capable at doing this is because I treat special operators as well. – So how do you diagnose them then? – I will tell you more after the podcast, but we send them to old school infectious disease guys, like in their 80s and 90s, that do old school, multiple stool samples, and they all come back positive,

and they come back positive for, again, and to me, by Hisalytica, I had one guy that had schistaminiasis, and they find it, and we treat them, but more importantly, they all get better.

Here is the ringer, again, terrible mom jokes, but you have to treat their spouse. – Oh, wow, yeah. – You have to treat your spouse. – That makes sense. – Right, and so you can treat one person, full resolution of symptoms, but if you don’t treat the partner, whether it’s back on the toilets or the bedsheets or whatever, they all get it back.

– I’m just laughing because if they’re going to go see you and then you end up diagnosing something like that, this is like how it was when I was in high school where if somebody got an STD, you’re supposed to call everybody that you’ve been in contact with. – Yes, no, no, it is funny, but most importantly, these guys all get better. – Oh, wow, that’s awesome. – But we’ve had to go to extreme measures to find parasitologists to send them to these old school places, and it’s tough.

I want to move on from small intestinal bacteria overgrowth

to, I would love to, there’s a lot to cover. I’d love for you to mention something on chronic constipation, and if that’s treated, again, because there’s probably primary causes behind that,

and then whether laxative use is safe, I just want to mention that because I also really want to talk to you about colon cancer and how we should probably be screening much earlier than 45 because we’re seeing an influx of individuals

that are getting sick.

But before we go down that, I would love to hear about this chronic constipation.

– Chronic constipation is so common. That’s another thing that it’s just, it’s in our society.

The thing about constipation is divided into two different buckets for me. How often are you called to the bathroom? And when you are called, do you feel that you can fully evacuate? Those are the main things because if you go to a doctor and you say, “Well, I go every day,” great, you’re not constipated, but don’t really ever feel like I’m completely emptying. Well, then by definition, you’re constipated, not by any clinical criteria, but because you’re not feeling it. And so when it is a motility thing, or when I say that you’re not called to the bathroom, hold on, it’s like, I don’t even get the urge for three days. We need to retrain your bowels to try and go to the bathroom. Unfortunately, pharmaceuticals that are out there, the ones that we have available, real hit and miss. And so sometimes they’re just complete, like, bowel preps that make it, you have to stay home and take it. – Are you saying that the pre-colonoscopy, fun enjoyment of brutal? – Well, in some times, and it’s unpredictable.

One of the two drugs I’m thinking of are Linz S and True Lens.

What’s interesting about them is that they actually are peptides and tiny little peptides that you can’t find in the bloodstream, but they get converted into the active component and then can cause a ton of diarrhea.

So, but if it’s not causing diarrhea, then people aren’t really going to the bathroom at all. So they’re having no response to it. – And why is that? – Well, I think it has something to do with lipase cleaving it. That’s because you can actually have a better response if you take it with some fat,

that’s a clinical pearl. – Yeah, it makes no sense at all though. Well, here’s why. – That’s okay, but that’s a really good clinical pearl. – Well, here’s why, because I’ve met with their scientific liaisons and they’re saying that if somebody doesn’t respond, try having them take it with some fat, bacon, butter, something like that. That seems to help it along. And when I’m asking why, they’re like, well, it just seems to work better. And the problem is when you take fat, it actually causes something called an ileal break. So when you have fat, which is why you stay full longer, it actually slows everything down and it doesn’t actually trigger like an immediate bowel movement, but this happens to be a medication that they don’t fully understand exactly how it works. So it is a peptide. My theory is that when you have fat, gastric lipase is released, it cleaves it into its active form. So when you take it, if you don’t have lipase, so I have tested this. – Yourself. – Not on myself, but I have tested it on severely constipated people. And I’ve given them pancreatic enzymes, plus the Linz S and told them to take it at the same time. And I was told that it was more than a bowel prep for a colonoscopy. And I’m like, okay, so that makes sense. So there’s something with that. So a lot of these drugs that get approved, there’s still some confusion about how they actually work. They just know that it’s safe enough for the FDA to say, okay, do it. So if somebody’s not going enough, then it is what is the appropriate combination of fluid, fiber, soluble fiber and soluble fiber, and an osmotic agent? And those osmotic agents are magnesium citrate, magnesium oxide, MiraLax, that’s PEG, these different things.

And so how do we get enough fluid in there so that your colon can then start contracting and at least moving things along quicker? Sometimes a stimulant is necessary. – What kind of stimulant? – Well, it could be a natural one like Cena. – Okay. – Or it could be, which is,

I forgot what the actual natural name of it is, or Bisicodal is the pharmaceutical one, which is Dolcollex. – Dolcollex. – To get people, because what ends up happening is– – Caffeine or nicotine doesn’t. – Caffeine and nicotine both. Caffeine has caprylic acid, which works as a stimulant, and nicotine, definitely, which is why back in the day, people would wake up, have coffee and a smoke, and have to go and have to use the bathroom. Nicotine, definitely, because it actually can hit the nicotinic receptors, which stimulate motility, for sure. So, but I mean, telling people that I want you to take some magnesium citrate and smoke half a pack. – Or a nicotine mint, side of nicotine. We’re not saying to do that, guys, but– – Yeah, those– – You’re talking to a shop over here, yeah. – Yeah, those definitely can actually stimulate that. And then using a stimulant as necessary, people are very scared to do it, they don’t wanna become dependent and everything. – And is that a true thing? – It’s not, it’s the old stimulant medications that we had would damage the nerves. Those no longer are there. – And what were those? – I don’t remember what it was. It was, anyways. But it was an actual compound that would actually damage the nerves, and then you would actually become dependent. But they got rid of that compound. – So for example, daily use of Cena would be acceptable. You are not worried that someone would become dependent on a laxative. – I am not worried about it, but it’s something that we don’t want. We want you to train your bowels. And so the actin and myosin– – Like potty training for adults. – It’s basically potty training for adults. And so my wife’s a rehab doctor, and so she would run these inpatient rehab units where you have to retrain bowels in somebody that has a spinal cord injury and things like that. So that kinda comes onto that. Like your bowels can be trained.

What I tell my patients is that, like your muscle, your colon has actin and myosin also, and the more it gets stretched, the weaker the connections are. Same thing if you’re a bicep. – Look at those guns. – But I’m weaker here versus here to here. I have more actin and myosin. And so what we wanna do is try and make sure that you have the most muscular propulsion. When it gets stretched to the point where it can’t contract, it’s called toxic megacolor. – Yes. – And then it just sits there. – That’s like an emergency. – It’s an emergency, and it sucks. It sucks for everyone, everyone. The patient and the doctor.

So it’s just a matter of, if you haven’t gone in a couple days, I’d rather not say we’ll just keep putting up with it. Let’s give you a stimulant now.

And take a stimulant, if you haven’t had a bowel movement in two to three days, take a stimulant so that time it, you take it overnight, wake up, have a bowel movement, and then let’s try and go longer and longer and see what we can do about bowel training. That goes hand in hand with pelvic floor issues. So a lot of people. – Men and women? – Men and women, more women.

There’s a lot of things associated with it. We can go back to childhood trauma, we can go to stress, we can do different things, we can go to the phone, people taking their phone to the bathroom. – I don’t know anyone who does that. – I know. – Matt, just kidding. – He’s in the bathroom with his phone right now.

– I have to bust his chops. – It all comes down to the same thing, that you have these muscles and you have to allow them to relax to have an effective bowel movement. The brain doesn’t understand that it’s not relaxing, and so you think that you’re relaxing when it’s not happening. So I’ll bring people in, and the most effective test is just basically have them squeeze on my finger with their anus, try and relax. – Don’t try that at home, folks. – Yes, and then try to expel my anus. And it sounds weird, but– – Spell your finger. – I’m sorry, spell my finger through their anus, correct. – And by the way, this is like when we talk to a urologist, there’s lots of penis talk, and now you talk to a gastroenterologist, there’s lots of anus talk, this is just– – It’s just normal. – Hard for the gourish. – Yeah, it’s just normal. But it’s fascinating because so many people that have constipation, nobody’s happy about it. – Right, of course not. – But I’m like just trying to expel my finger, “Oh, I don’t wanna do that.” I’m like, “Just try.” And then when they do, I feel the internal, it’s called the pedental muscle, just clamp down. And they’re like, “I’m trying.” I’m like, “Okay, now watch this and I’ll pull on it.” And I’m like, “Okay, do you feel that?” They’re like, “A little bit.” I’m like, “Just relax, I’m gonna hold my finger here, now do it.” And then they get it. And that’s where biofeedback and therapy comes in. Really easy to fix. – And one would address that by seeing a pelvic floor specialist, a PT, right? Physical Therapist. – It’s a physical therapist that specializes in pelvic floor therapy. And there’s different, so that is the root cause. I’m sorry, that is the end mechanism. The root cause of why that’s happening could be different things. It could be that you’ve had chronic constipation for so long that just pushing like crazy, the wires get messed up. There is an association with trauma of various kinds of trauma because your pelvic floor is a core muscle. And you can hold a lot of emotion there. And that happens. And then there’s also this whole phone thing. It sounds silly, but it’s done wonders for my hemorrhoid business. – Really? – Yes. All ages, all ages. It’s fantastic.

Because people go to the bathroom with their phone and they get triggered and they sit longer. – Holy cow. – Yeah, they can get emotionally triggered. And when you’re emotionally triggered, you can’t, it’s that fight or flight versus rest and relax. You need your body to completely relax. – Well, while we’re on the topic of pooping, the squatty potties that change the angle of your,

would it be the pelvic floor or is it the, some muscle? – Yeah, it’s that muscle. – Is that a good thing? – It’s a great thing. Yeah, I love it. – So you believe that there’s positive benefits to changing, to raising your,

it’s like raises your, it has you squat instead of seated. – Yeah, so what you do is, all it does is get your knees up above your hips. And if you lean slightly forward, and there’s tons of data on this. There was an article that’s kind of funny. The Japanese did this. They took like 10 medical students. – Always the medical students. – Always the medical students. And they repeatedly filled their rectum full of barium. And then they would have them poop it out in various positions until they found the most effective angle. – Friends, this is why you should never become a medical student. – Yeah, and they, and what they determined is there’s an actual angle too far, and it may change, but there is an angle. You know, when you go to other countries that they squat when they go to the bathroom, they don’t have constipation or hemorrhoid issues. – So there is a physical way in which we were potentially designed to go to the bathroom. – 100%, and Squatty Potty gets you almost there. – You should have developed that. – I know. – You should have invented, I mean, you did an amazing job with Atran Tio. We use it in all our patients that we’re bridging them from

for SIBO treatment, but you know, Ken, you really should have thought about this Squatty Potty. – We kind of missed the boat on that one, yeah. We may have a branded Squatty Potty, I don’t know. But no, but honestly, they did a great job of at least getting it out there. There’s tons of different brands out there now, but definitely. – I am going to give you, I had five rapid fire yes or no questions. – Okay. – You don’t get to comment. It is fully yes or no. – Okay. – Okay.

Mouthwash. – No.

– Laxatives. – Yes. – Diet Coke. – No. – International travel. – Yes. – Sushi. – Yes. – No. – Yes. – That is sushi is like full of parasites. I– – Love those parasitic sushi. You’re eating, okay. – No, I can’t, really? – Well, now hold on. – I told all my patients, no sushi. Guys, if you’re listening, if you are in Ken’s camp, carry on. If you are my patient and you are listening to this, okay. – This is supposed to be yes or no, but go. – I’m just saying that if you’re getting gas station sushi here in Houston, maybe no. – I don’t think it matters.

You guys are gonna get Giardia, definitely gonna get some kind of worm. – So caveat, I always make sure I have a little sake to kill whatever organism is there. – Ken routinely deworms himself.

(laughing) Okay, all right. – I’m a huge sushi fan. Well, not after this. I’m gonna have to send you some literature. GLP one agonist. – Oh, are we still on yes or no? – We’re still on yes or no. You sidetracked me with the sushi because you said yes, but GLPs. And the reason I’m asking a gastroenterologist about GLPs, GLP one agonist, or even the trisepatide, which is two mechanisms of action, is because, again, this is coming from your perspective from gastrointestinal health, but it’s only yes or no. Does it put you on the spot? – No. – Okay. – But this one’s a total caveat.

Essentially, it’s yes for the right people, but no the way it’s currently just being tossed around a whole lot.

I see too many people, and I’m really biased on this, and we see too many people that come in with a stomach full of food and they haven’t eaten in two days.

So I’m like, mm, this is, I’m letting it play out a little bit longer. I mean, I think it’s great for some people. – I know, but that’s why I make– – Eric and I did this whole podcast on it where we kind of waffled, because I’m like, I think it’s really beneficial. At this last meeting I was at, a anti-aging doctor was talking, she said that we really believe that this is the most,

the biggest impacting medicine that we’ve had in decades. – I agree. – And I agree with that. I’m just– – You are a gastroenterologist, and you care about– – I see the negative side, and I’m just waiting for it to, I can’t in good conscience say, please go do that, because if you get permanent gastroparesis, or if something like that happens– – But I don’t think that’s gonna happen, because it doesn’t affect the nerve.

– Yeah, but how is it causing, how is it causing gastroparesis then? – I think, I mean, so I, I mean, I have my theories on this. It just delays gastric emptying, and that’s exactly what it’s designed to do. If you give it to someone who already struggles with constipation, now we’re talking about something else. So if you have someone that actually already has a damaged GI tract, or is really struggling with chronic, I mean, so basically, if you have someone who, let’s say they have damage to their nerves. Let’s say they have diabetic gastroparesis, or even some kind of Lyme can cause nerve damage, whatever it is, and then you give those people

GLP1 agonist, then you’ve got a problem. But I haven’t seen any data that says that, and again, I just don’t buy it. – Yeah. – I think that they’re really good drugs. I think we have to determine who is utilizing it and who is not. – Yeah, and who’s utilizing it the right way? Are you maintaining your muscle? That’s the big scary thing. – I will also say there’s no direct mechanism of action that says that you couldn’t. We put patients on GLP1s, and I mean, I use more of the tricepidide, the dual agents. We track all their muscle. We track their body fat,

and they do not lose skeletal muscle. – Really? – No! – That’s great. – It’s because they are training and they are prioritizing protein, and we have all the other pieces in place. The reason that there is such pushback is because people are losing body fat and they’re losing skeletal muscle, but there is not something inherently about the mechanism of action that actually affects skeletal muscle. – Yeah, my pushback is a very, it’s a soft no. – Yeah. – Because I’m just sitting on the sidelines, actually. – Well, you were a yes on sushi, so now you’re in big trouble. – I know. But I will say this. Everybody talked about ozempic and everything, but it is just a peptide. – It is. – And you were the first person to ever even talk to me about peptides, literally like six years ago. And I love peptides. I think that’s the way, if the FDA would just get out of the way and pharma would get out of the way, there’s so many incredible things that can be done with that. – And just to be clear, we are definitely not giving anyone medical advice. We are both practicing physicians, and the FDA did come down really hard on peptides, and peptides are just a string of amino acids all put together in particular ways. We, there are peptides like, again, CJC Nippomorlin and BPC157, which seems to have some good impact on gastrointestinal health, but the FDA did come and take many of them off of the market for physicians to prescribe. – But– – All the good ones.

– That being said, GLP1 agonist, ozempic, moderna are all peptides as well. Let’s pivot a bit to screening. – Yes.

– Let’s talk about colonoscopies.

Let’s talk about colon cancer, and when you think individuals should be screened, and what are your thought processes from both endoscopy and colonoscopy. – So the current screening guidelines are everybody age 45 and older, you start your screening process. If there’s a family history of anybody with a polyp or cancer, you start at 40. Those are just kind of hard start times. – Polyp, just as, most people have had polyps, right? – So then, that’s the interesting thing, is anybody in your family that ever had polyps or cancer, and they’re like, no. And then when they come in for their scope, like, I actually asked my mom, and she’s been having these for years. It’s something that nobody ever talks about. – Right, you don’t talk about at the dinner table. – Yeah, it’s not just cancer, because we know that colon cancer is the second leading cause of cancer death in the United States.

– Which is crazy, because it is a very slow-growing cancer, isn’t it? – It’s a slow-growing cancer, and we have a cure. The cure is colonoscopy, because we know that these cancers, almost all of them, start out as a polyp, and then they grow into cancer. So as they grow into cancer, we can remove those polyps before they become cancer. – So they all start, and how common are polyps? – Extremely common, and so every– – So don’t be concerned if you go and you have a polyp, and then the recommendation is it in five years that you can take? – Three or five years, traditionally, depending on the size of polyp, how many you’ve had, things like that. But they’re common enough that we’re judging gastroenterologists about their competency on their adenoma detection rate. What is the percentage– – Wait, wait, wait, say that again. – So we’re being watched to make sure that we’re having adenoma detection rates, ADRs,

which are at a certain level. And so we know that in a certain population, we should be achieving an ADR of at least, I don’t know, 32% or something like that. – Meaning you should be able to catch– – Meaning that everybody off the street at least, I don’t even know what the actual bare minimum is because all of us are significantly higher than what is required. But I wanna say that most of us, over 40%, 45% of all the colonoscopies that we do, we’re finding a precancerous polyp. Now what’s really scary is we’re finding even really young people now, 30s, 20s– – Is it because we’re screening or– – No, because we’re not even screening these people. I’m seeing them for bloating, pain, things like that. And then I get in there and it’s like, wow, rectal bleeding, and then it’s like, wow, there’s a polyp. This is really interesting, you’re in your 30s. We would have completely missed this, and in 10 years that would have been cancer. That’s what’s a little bit scary. So when you say, when should we start screening?

All you have is a hammer, I’m like, start screening, the second you’re old enough, above 18, to make your own choice.

But we are seeing a lot of people that are, we’re scoping them for other reasons, and we find precancerous polyps in their 30s. – Why do you think we’re seeing such a massive increase? – No one knows.

An article, I guess it was two years ago, was the first one that actually looked at this and showed that the children of this generation are having higher colon cancer than their parents. So stop and think about that. The parents are now in their 70s, and the kids in their 40s are having colon cancer. It’s the first generation ever to have this. Is it diet? Is it disruption to the microbiome? Is it disruption to the microbiome? Is it other factors, immune response to whatever, infections, things like that, who knows?

– Your kids, have they been screened? Rescreening them yet? – No, not yet, no need to, still file that, 19 and 17.

But certainly, I think when, I got my first screening when I was, just because I was seeing stuff. – Yeah, but also you’re a gastroenterologist, and everyone should know that whatever physician, whatever specialty the physician is, there’s the medical student syndrome, and then there’s the residency syndrome where whatever you’re in, it’s, I don’t even have a prostate, and if I was a urologist, I’d probably be, I definitely have prostate cancer. – I know, we gotta, now I’m so paranoid because I have patients that, so many of them are getting prostate cancer. I’m like, can’t, and so they’ll come in and tell me. They’re like, oh, talk, you know what I mean? I get all worried, I’m like, could somebody do a prostate exam on me? It’s all my nurses. – Well, Shane is home today, so you just might be in the back. – But he’s gotta figure out how to do some sort of at-home tracking, like we can now for cholesterol, like we can now for diabetes, like we can whatever, some sort of– – What about Cologuard? – PSA, oh, are we off the yes-no, please say we’re off yes-no. – Well, you only, typically I do five yes-no because Matt really, he thinks that this is great, the yes-no, we are off yes-no, but Cologuard, because a lot of people don’t like to get colonoscopies, and I’m hoping you guys understand, it’s critical. I mean, nobody likes it, but– – So Cologuard is a test that is, number one, the company is heavily funded by large venture capital. That’s why you see commercials all the time for it. – I haven’t ever seen a commercial one. – Oh, really? – Yeah, maybe I don’t watch TV, so. – They have their own PGA tournament, they have– – Get outta here. – Yeah, the Cologuard tournament. So Cologuard is a test that looks for aberrancies in DNA in the stool that can determine if you have colon cancer. The problem with Cologuard is that the sensitivity and specificity, meaning the likelihood of it actually, of you actually having cancer if it’s positive, is very low, so I’ve treated, or I’ve scoped, I was keeping track for a bit, but it’s gotta be somewhere around 120 people now that have come in with positive Cologuards. The look on their faces, I’m dying of cancer. – Terrified. – I’m terrified. All 120, no cancer.

– Wow. – Then if you read the data on it– – Wait a second. – Yes. – Now that’s very, now that’s false positives that really– – False positives. – Reach people out. – And these are people that may have had two Cologuards. – Oh, man. – And then one was negative, one was positive, one was negative two years ago, one was positive.

The problem is it doesn’t pick up polyps at all. So you’ll have these people, and if it’s positive, you’re getting a colonoscopy. Here’s the rub. If you’re wondering, well, why does it even exist? Well, it’s going after the insurance reimbursement for colon cancer screening. So the worst thing, insult to injury, is when somebody gets a Cologuard positive, and their insurance said, okay, we’ll pay for that, because this is your screening exam, but now they need a colonoscopy, and they’re like, well, we already paid for a screening. Now you’re on the hook for a deductible. So they got one for 100% paid, and now they come to me, and they have to pay out of pocket for it. So that’s part of the problem. So no, not a fan of it. – Okay. – It’s, I only, only use it when I really don’t want to do a colonoscopy, and somebody’s 112 years old, and they’re scared. I’m like, all right, will you get a Cologuard? God, please be negative, please be negative. – Yes. – Then I have to do it, yeah. – The whole thing. – Yeah, so not a fan. Definitely it’s, and then once, all my patients that were scared to have a colonoscopy, once they have one, they’re like, this is just not a big deal. You come in, you go to sleep, you wake up, and you’re done, and you have a piece of mind. – Yes, and you might get a bracelet. – And you might get a bracelet that says, what would your microbiome say? Yes. – Dr. Ken Brown, I love any time that I get with you. We could go on and on. I’m hoping that you’ll get back on that plane that you flew here, and we will do a whole second episode, because there are things that we didn’t get to cover, like reflux. I like– – Yes, I will tell you when we need to do that whole reflux talk. I got it, because that’s what I’m doing research on right now. – Tell me, because I would love to have you back on to talk about reflux and H. pylori, and all of those kind of things. So tell me what you’re up to. – Well, the biggest thing with reflux is that it is the most common disease. It’s the most prescribed medication. This whole class of medication is called PPIs. The problem is, is that now, since we’ve had them out there for 30 years, it appears that PPIs, proton pump inhibitors, Nexium, privacy, you see them.

There really seems to be some correlation with causing dementia, causing osteoporosis. – Is that because of the impact on the mineral absorption?

– I don’t think anybody really knows. They just know that it’s a correlation.

Two sides of it are, well, maybe the data’s pretty weak, but the reality is, if it’s contributing to that, and there’s other ways to fix it, then maybe we should not just be shutting off the acid. Maybe we should work on doing other things, like tightening the lower esophageal sphincter, maybe making the stomach work better, and move the right direction, things like that. And that’s what we’re working on right now. – Well, I cannot wait. Again, we have shared patients together, and I have consulted you with pretty chronic reflux, and there’s all kinds of things. So I am so excited for you to come back on and talk about it, because I think that you are amazing. – Thank you. – I also believe that your heart is in the right place. You are truly trailblazing and very much an intellectual who wants to see the evidence and a natural way to move things forward. And get really great results for people. I think you are a physician, and the way in which you’ve shown up is something that is just very admirable. – Well, thank you. I think that there are lots of things that inspire us, but I’m very grateful that I happen to have a job that I like, where most of the time I can help somebody. And then in the science part of it, these little dopamine rewards of figuring stuff out. So I work with a lot of people that seem to do much better financially, but I don’t think they’re happier than me. – Yeah, or they’re not fitter than you, but that’s for sure.

Where can people find you? – They can find me on Instagram, at gutcheckproject.

My website, my medical website for those kind of things is KennethBrownMD.com. And then things like the SIBO Support Box and these other ancillary things, it’s KBMDhealth.com. – And the things like Atron Teal.

I think that the products that you’ve developed are extraordinary. We use them in clinical practice all the time.

It’s just part of our protocols. – Yeah, and just go to atronteal.com, A-T-R-A-N-T-I-O. – We’ll link everything. Thank you so much for your time and your energy and your jokes, which are pretty good. Of course, mine are marginal, but well done, sir. And again, thank you so much. – I’m gonna go back to the hotel, get on that battle bike and turn you up to speed of three on the audio book. – I will be happy to yell at you on your intervals. Thank you so much. – Awesome, thank you.