Welcome back to the Healing Pain Podcast with Dr. Vincent Pedre.
I have an exciting guest today. We’re going to be talking about gut health and everything that’s related to gut health. Before we start the podcast today, I want to give a special shout out and thank you to the American Academy of Orthopedic Manual Physical Therapists for voting The Healing Pain Podcast as one of the Top Ten Up and Coming Podcasts for 2017. They’re a great organization so please check them out at AAOMPT.org. Once again, thank you for the support.
If you’re interested in nutrition and how it impacts musculoskeletal pain or pain in our immunity, please check me out at PT NEXT, which I’ll be presenting on June 23rd in Boston, Massachusetts. I want to thank the American Physical Therapy Association for inviting me to give that lecture.
Last but not the least, if you are a practitioner and you’re interested in further lectures or information or continual education, be sure to hop over to my website at www.DrJoeTatta.com and click on the Practitioner page and sign up for information.
If you struggle with any type of digestive problem, a condition such as irritable bowel disease, irritable bowel syndrome or if you have headaches, chronic pain, autoimmune disease, allergies, mood problems or looking to lose weight, this is the show for you.
My guest today is Dr. Vincent Pedre who is a functional medicine physician here in New York City. We’ll be talking about how to heal your gut as well as try to just keep it healthy and of course, happy.
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Your Journey to Gut Health with Dr. Vincent PedreN Lifestyle with Dr. Melissa Cady
Dr. Pedre, welcome to The Healing Pain Podcast.
My pleasure. Thanks for having me here today.
As you know, nutrition is one of the main strategies I talk about as far as general health, and of course to impact someone’s pain or chronic pain. You have a great book, it’s called Happy Gut as well as your website, HappyGutLife.com. You have a great book. In the beginning of your book, you talk a little about your journey into gut health, which started at a very young age for you. Tell us about that journey.
This was a journey that began at a point in my life when I didn’t realize that it was anything abnormal. I always had a sensitive stomach. From that, I ended with a lot of problems because I was on so many antibiotics as a child. I basically was on some antibiotic once or twice a year for bronchitis, pneumonia, sinusitis, throat infection. There was no thought on the part of the pediatrician that they were causing a lot of damage to my gut flora. As a result of being on so many antibiotics, what happened is I became sensitive to foods that I was eating every day.
Unbeknownst to me or to my parents, I was becoming sensitive to gluten and to dairy. It’s not something that happens overnight. It took me years to figure it out. It wasn’t until college that I figured out that I had some issue with dairy. My immune system was totally shut. I could pick up any virus. Anytime somebody was sick, I would get sick. I thought that not only do I have a sensitive stomach, but I just have a weak immune system and I need to stay away from anybody who has a cold, as if they were a vampire, I have to stay away.
When I got to medical school is when I changed my diet for the first time. I started incorporating more healthy fats and I took dairy out of the diet. I didn’t have as much dairy as I have been having. No milk. I stopped having milk with cereal. The first thing I noticed is that I stopped getting sick as often. That was my first a-ha moment. Even though we weren’t getting any nutrition training in medical school, we were taught to be keen observers. The most important person to observe is yourself as you’re going through any healthcare training because you can learn so much from your own health challenges. I noticed that I wasn’t getting sick as often. I was like, “I wonder if there’s a correlation? Because the only thing that’s really different is that I’m not eating dairy as often.”
We know now that 70% of the immune system is located all along the lining of our digestive system. That lining is huge. It’s 20 feet long for the small intestine, another five to six feet with the colon. If you take out the aggregate surface area of the small intestine because it has all these folds, these villi, it’s the surface area of a tennis court. It’s gigantic, this huge inside-outside world that we have. Our greatest source of exposure is what we eat, what we put through our mouths. It wasn’t until years later that I can look back and say that I had developed gluten sensitivity all along because I had learned to live with my sensitive gut and my irritable bowel. I thought that, that is just my normal.
I think for a lot of people listening, they probably lived with symptoms that they’ve just tuned out because they just think, “That’s my makeup. That’s the way my life is going to be.” They don’t think that there is a way out. For a long time I thought, “This is just the way my system operates.” It wasn’t until I took out gluten and refined my diet. That’s when I was learning functional medicine. I was starting to do it with the patients and I decided, “I’ve never really explored whether gluten is an issue for me. If I’m preaching this to my patients, and I’ve always been the type of doctor that I walk my talk, if I’m telling people to take gluten out of their diet, why don’t I do it also?”
Let me do it as an experiment to see one, how difficult is it?” What I learned was that it really isn’t as difficult as people say it is. Two, within a couple of weeks, it only took a couple of weeks, I felt different. Something that I didn’t realize was related to eating gluten, I felt much more mentally clear. My energy, which would dip in the afternoon, suddenly was pretty constant throughout the day now that I had taken out. Lunch was probably the biggest culprit for gluten because some days I was having a sandwich for lunch. Sandwich is very easy. It’s quick. When you’re changing your diet this way, what you have to do is you have to reprogram your mind because eating becomes this very subconscious thing that we do. We don’t really think about it, you could be reaching for something before you actually realize what it is that you’re reaching for. It took me a couple of weeks of stepping out. Usually, I would step out for lunch. To think, “Where am I going to get lunch?” Because I know I can’t get a sandwich or I’m not going to have anything with wheat. I just had to reorganize how I thought about lunch. I had to upgrade my operating system. Once I did, I had a new way of eating.
I did it as a month-long experiment but I felt so good at the end of the month that I said, “I’m going to continue this for another two months.” I felt even better at three months that I decided, “I’m going to continue for another three months and see, at that point, at six months, can I test out gluten and see if it causes any issues.” What I learned at that point was that, now, if I had gluten, it gave me a signal that I never heard before. The really interesting signal for me, in my body, was it would cause itching on the inside of my wrist. I would get slightly red rash and they would get itchy as soon as I had gluten. That was only after a couple of bites. Of course, the scientist in me says, “Could it have been a coincidence? Let me test it again on another day and see if this happens.” I tested it again on another day and it happened again. Then I decided, I’m going to keep gluten out for another six months because I’m feeling so good. When I got to the end of the year, I felt so good not having gluten that I decided, “This is going to be my life now. This is my new lifestyle.”
It’s a great story and I think a great introduction to talk about gut health today on the podcast. One of the things you mentioned way back in your story here was that you were on antibiotics and started when you were a kid. When a patient comes to your practice now, in functional medicine, you do a history or what’s called a timeline. You basically go back into that person’s history in their life and sometimes even into the life of, let’s say, their mother or even their father. How many antibiotic exposures are you seeing that people have throughout their lifetime before they get to someone like you?
Just think that the CDC came out with a statistic just about two years ago that four out of five American adults are on antibiotics at least once a year. That is a lot of antibiotics. When you sum that up over the course of a lifetime, people have been on antibiotic courses probably 10, 20 times, 30 times, maybe even more than that. I don’t have these as often anymore, but I used to have the patient that would come in and tell me, “Just give me an antibiotic so I can nip this cold in the bud.” It was a struggle to educate them that a cold is usually a virus. You don’t give a virus an antibiotic. Even if you get better just because they gave you the antibiotic is probably just a coincidental in time. It’s not a cause and effect. There’s a placebo effect, just the idea that you’re taking something for that.
One thing that I wanted to point out is that an antibiotic, for example, like Cipro, a couple of years ago, they looked at what does Cipro do to the gut flora. It takes twelve months for your flora to recover from one course of Cipro that could be five days long. Very common antibiotic that’s prescribed to women, for example, for urinary infections but it also was being used a lot for respiratory infections. I certainly was given Cipro at least once a year during my late teenage years. I had no gut microbiome. It had been wiped out. Other antibiotics, they will alter your gut microbiome for three to six months. It takes a long time to recover. If you are one of those Americans that are on an antibiotic at least once a year, you’re basically living with a decimated microbiome and setting yourself up for all sorts of inflammatory issues.
We’re talking about the importance of the microbiome. It’s important in having a strong and vital immune system. Can you make the connection between the function of our immune system, how important that is, and our gut microbiome? Because the average person, when you say immune systems, they think about maybe some white blood cells that are floating around in our bloodstream that attack viruses. That’s probably about the extent of what the average person thinks of the immune system, but we know it goes much, much deeper. Can you talk about that a little bit?
Let me define a few things. The microbiome is this vast collection of microorganisms. It’s much bigger than we understand right now. When we think of the gut microbiome or we’re talking about microbiome, we’re talking about usually the gut, but there are microbiomes in all mucosal surfaces. The sinuses, the mouth, the hands. Each microbiome, you can think of it as different countries. Each zone has its own unique set of bacteria. The gut microbiome has about 100 trillion organisms. Out of those, there are 400 to 600 different species in one person. When people think of taking a probiotic that maybe has eight different strains, just think about that, that’s just eight strains in comparison to the 400 to 600 different species that are inside our gut.
We understand that this microbiome lives in a very, very small, very thin area at the very edge of the gut lining, the interior lining. It’s only a few nanometers thick. In that region, the bacteria interact with our immune system. Think of the immune system like our permanent Afghanistan. We have troops, our white blood cell, they are known as dendritic cells. They’re sitting all along the lining of the gut. They’re just looking at everything that’s coming through. They’re like our customs officers. They’re checking everything that’s coming through and saying, “Good. Good. Good. Bad, react. Send a signal up to the T cells, the B cells. We got to instigate an immune response here because there’s bacteria getting through.” That’s where leaky gut syndrome comes in.
Before that, if you have a healthy microbiome, the belief is that, that microbiome is communicating, We’ve evolved symbiotically with this set of bacteria. They keep our immune system primed, but they also control the immune system so it doesn’t overreact. You want an immune system that is an Olympic athlete but you don’t want to be releasing that athlete all the time, but you want it to be there when you need it. The good bacteria, they keep the immune system in that ready attention mode, but they also keep it from overreacting. Then you get something like leaky gut. We mentioned antibiotics. What is a leaky gut? If you’re on antibiotics, if you’ve been exposed to pesticides, the glyphosate, which is one of the most commonly used pesticides known as Roundup, that can poke holes in the lining of the intestine.
Just like if you have a leaky faucet in your home, if it keeps leaking, then you build up mold and those mold then spreads and allows toxins to get into your body. The leaky gut is going to allow bacterial proteins, something called lipopolysaccharide or endotoxin to get into your body. It’s a very potent stimulator of the immune system. Then you get this system wide inflammation because the body doesn’t care if inflammation is just in one part of the body. I think of it as, back after 9/11, we have the terror alerts, so we could be in orange, yellow or red. The same thing with your body, if you have a zone of attack in your gut, it’s going to send a system wide alert like, “There’s an attack going on. All white blood cells prime up.” That’s part of the theory of how autoimmune disease can evolve, is that it starts in the gut with a dysfunction in the immune system. It’s much more complicated than that. That’s one way to look at it because that is our biggest surface of interaction and also our biggest potential for creating internal problems.
Because of the over prescribing of antibiotics, it starts with that at a very young age. We’ve learned that childhood ear infections do not really require antibiotics. For the most part, they heal on their own. But until a couple of years ago, that was the standard of care. A two-year old, a three-year old was getting antibiotics for ear infections when they really didn’t need them. They just needed support and their bodies would resolve the infection anyway. I think we’re outgrowing that now, but we were definitely in a phase where there was this collective consciousness amongst patients that antibiotics are good and that they’re necessary. I’m not saying that I’m anti antibiotics in all cases because I have saved people’s lives with antibiotic, but I am very much against over prescribing of antibiotics and the judicious use of antibiotics knowing that everything we do, for every action, there is a reaction. When you give somebody an antibiotic, you are disrupting their gut flora. You are possibly causing leaky gut syndrome. You are possibly then leading them to have food sensitivities and food allergies. Just think of the number of people now who suffer from some food reaction. We have all been consequences of that.
When we talk about gut health, when you pick up a book, let’s say your book, Happy Gut and you look at it. The first thing when we think of gut, we think someone might have gas bloating, diarrhea or irritable bowel syndrome, some type of potentially an autoimmune disease of the gut. Tell us about some of the extraintestinal symptoms that people can get when they have a gut problem, leaky gut, intestinal permeability, and what that looks like in the other parts of the body?
Let me start with this very simple example from a patient that I saw many years ago. She had hives. The hives were really bad. They would come on out of nowhere. They could come out on her face, her body. She would swell up so part of her lip could be like this big red thing. It was not only uncomfortable, but also unsightly. She was trying to find a solution for it. She had been to about five different dermatologists in New York City by the time she came to see me. She had heard about the work I was doing, and this was very early on for me when I met her. I thought to myself first as she’s telling me the story, I’m thinking, “How am I going to think about this rash in a way that’s different from all of these dermatologists?”
The first key is that, instead of looking from the outside in, I’m looking from the inside out, looking for the root cause instead of trying to apply a band-aid on the symptom. It turned out that she was from Ireland. I do believe that if the genetic pool is still not dilute, that people evolve genetically to eat the diet that their ancestors ate. Wheat was not a part of the ancestral diet in Ireland. Interestingly, it turned out, even though she did not have the antibody markers for celiac disease, she did have the genetic predisposition for celiac. She tested positive for that. I told her, “I’m just going to tell you something off the wall. I think that wheat gluten could be the factor that’s driving this immune response and causing these skin rashes.” She looked at me like I was nuts, “But I have no gut issues. I have no problems with my bowel movements. I don’t have any bloating. I don’t have any abdominal pain, nothing.” I said, “Let’s just go by faith. All I want you to do is give me four weeks. Let’s go gluten-free. Come back. Let me know how it went.” I gave her all the resources. She took it and she ran with it. She went gluten-free. When she came back, her hives were 75% gone and barely happening.
It’s just one example of how a gut issue, an issue that starts with the digestive system can have all these extra intestinal manifestations. I see patients with fatigue, with mental fog, with migraines, with joint pains, with autoimmune disease. There’s a big correlation between Hashimoto’s, which is autoimmune thyroid disease, and gut health and gluten. There’s this cross reaction between the antibodies that form in the gut to a protein that is also found in the thyroid, which is my theory why a lot of people with thyroid have issues with gluten and that gluten might be the initial driver that starts to break down the thyroid and then allow for proteins that the body should never have reacted to, to get exposed to the immune system. The immune system loves to react to protein. All of these extraintestinal manifestations are really important to realize because a person, all they might be suffering from is chronic fatigue. They don’t know where it’s coming from and they don’t think that it’s their diet. But it could be tied back to the microbiome and to the diet and the health of the gut.
One of the things that I love as a clinician, is I love great simple frameworks that we can follow to either apply to our clinical practice or we can apply to our life. I know in your book you have a framework that you teach people and apply to life. Can you talk about that?
That’s called my Gut C.A.R.E. Program. CARE is an acronym that I came up with. First, choosing the care because a lot of people who have these types of issues are people that are caring for everybody else but themselves. Just to first bring the attention back to self, that you need to institute care of the self. Each of part of the acronym stands for a step in the program. The C is for cleanse, the A is for activate, the R is restore, the E is enhance.
Briefly, cleanse is probably one of the biggest parts of the program. Cleansing meaning getting rid of the bad bugs in the gut, and also getting rid of the inflammatory foods in the diet, but also looking at other things that relate to cleansing. What type of water are you drinking? Is your water a clean source? If you are changing your diet and improving your diet and eating foods that are good for you, what surfaces are you cooking them on? Because if you’re eating something that’s healthy for you but cooking them on a fire retardant surface, then you’re going to expose yourself to the organic pollutants that are in that nonstick cookware and they’re going to get into your body. I do a cleansing of the diet, a cleansing of the gut and what I call greening your kitchen. That’s all part of the cleanse part.
The last aspect of it is cleansing the mind of negative thoughts. It’s so important. I know you talk a lot about that in Heal Your Pain; the importance of mindset and intention. Because when you’re making these lifestyle changes, you have to get into a space of gratitude and positivity so that you can move forward and make the changes that are going to be not just temporary, but they’re going to be permanent in your life.
Activate is about restoring the function of the gut. Most of it is done through digestive enzymes. I think of those as if someone is hurt and they need a knee brace to help them get better. The digestive enzyme is like a knee brace that’s just helping your digestive system get to the point where it can walk again without the brace. That’s the idea behind activate.
Restore, as people might think, it’s about restoring the gut microbiome, because so many people, pretty much almost anyone, has been exposed to antibiotics at some point in their life. Restore is about restoring the microbiome, not just your probiotics. I do believe probiotics have a very positive effect for people, but through prebiotics also, through learning how to eat, what types of foods are going to build the healthy gut flora.
The E part, the enhance, is about healing the leaky gut. Healing those tight junctions, the connections between the cells that lined the gut so that your absorption can be normal and that you’re not exposed to say, partially digested proteins that are coming through your food. Here we use nutrients, like L-glutamine which has been proven to help with restoring the health of the gut lining. Also DGL, which is a licorice derivative, or even bone broth, which is very simple to make or now you can easily order a bone broth online and have a cup of bone broth every day. I also love using slippery elm bark for people. I have a recipe on my website for slippery elm bark porridge.
A slippery elm bark is not the best tasting thing so that’s why we came up with a recipe to make it more palatable. It’s what we call a mucinous bark. It forms this protective coating along the gut lining and it can really help reverse the leaky gut syndrome. It’s part of my integrated approach to getting people back to a healthy place where their gut is functioning normal. The remarkable thing is that, without treating other symptoms, they tend to get better on their own. You’re not going out and chasing every single symptom that a person is having. Through my program, I’m getting them to really change the way that they’re living their lives from the diet and mindset perspective. From that place, their body can heal.
I think the mindset is huge. I think when we talk about gut health, a lot of people leave that out. Even within the umbrella of functional medicine, the mind and stress is often a big part. Can you talk briefly on how stress affects the gut digesting the intestinal lining? Why people need to be aware of their stress? They could be doing everything perfectly. They could be leaving out the inflammatory foods, they could be putting in the good healthy foods. But ultimately, if there is a stressor, whether that’s an internal or external stressor in your life, that has an impact on your gut health.
I’m going to try to make it short because I’m thinking of so many things I could say here. As you talk about stress, I was thinking about a study that was done with two groups of people that were separated. They were all age-matched and put on the same diet and the same exercise program. The one difference between the two groups was that one group was not allowed to get a full night’s rest. They had interrupted sleep. The other group could sleep through the night. You can think of the sleep disruption or the lower sleep as a stressor on the body. It turned out the group that got enough rest lost weight, the group that didn’t actually gained weight.
There’s a connection there between circadian disturbances and what happens to the gut flora. Also when you’re in a high stress state, when you’re in this fight or flight response, you’re going to increase the epinephrine in your system, it’s going to increase your gut permeability. You’re going to develop leaky gut just from the stress. That’s going to expose you to endotoxin or food particles that are not completely digested, that your immune system loves to react to and it’s going to create inflammation. The body doesn’t like to let go of weight when you’re inflamed.
Another example is the fact that certain strains of lactobacillus produce GABA. GABA is an inhibitory neurotransmitter. It’s a transmitter that comes into the brain and it says, “Shh.” It just slows everything down and quiets things down. It’s a very important neurotransmitter at night time when you’re trying to slow down, relax and go to sleep. It’s also important during the day to not keep you in that wound up state. As we’ve learned that a big portion of neurotransmitters are produced by our gut flora, not in our brain. A big portion of the serotonin in the body, even serotonin receptors are in the gut and not really in the brain. There’s this very important connection between the gut and mood.
This is something really fascinating. Neuroplasticity and epigenetics. Epigenetics is on top of the genetics. It’s control of gene expression. It turns out that one of the products that is produced by the bacteria in the colon, it’s called butyrate, that’s a short chain fatty acid. Not only does it keep the colon cells healthy because it’s the primary energy source for the cells that line the colon, but it also diffuses into the body. It can get through the blood brain barrier. When it gets to the brain, it triggers the release of brain derived neurotrophic factor through an epigenetic effect. By doing that, it improves memory and cognition and neuroplasticity.
There’s direct connection between the health of your gut flora and your mind’s ability to remember, think and learn. It all comes back to the diet because it’s the type of flora that you’re feeding through the foods that you’re eating that then produce the butyrate that makes you healthy, because we can’t produce our own butyrate. We rely on our gut flora to produce this very vital important short chain fatty acid that has so many wide ranging effects. I can go on and on. It helps balance blood sugar. It reverses insulin resistance. It’s just so fascinating. It comes back to how important it is to have a healthy, happy gut as a gateway to having a healthy body and a healthy mind.
The articulation of the gut-brain that you just spoke about and how the gut flora, the microbiome can have an effect on GABA, which we know is an inhibitory, which is calming, makes you feel good. If don’t have enough GABA, typically, glutamate, which is excitatory, keeps you in this wound up state. We see this in people who are stressed out. We see this in patients with fibromyalgia. We see this in people who have something called central sensitization, which is their nervous system just won’t quiet down. I think that it’s beautifully articulated. No one really has talked about that on the podcast. Thank you for that.
I want to add, as you mentioned glutamate, because glutamate and GABA are like the two cousins that don’t like each other. Glutamate, which is an excitatory neurotransmitter, can also be produced by gut bacteria. It’s all about the balance. You can think of it as gremlins that either they take over or the good guys take over and they keep everything in check. They’re producing the nice things that your body needs. If they get decimated by antibiotics, then all these other bad critters can come in and take territory, and they start producing neurotransmitters that are just unfriendly.
I can’t tell you how many times I’ve seen people go through my program, change their diet, and then tell me that they feel much calmer. It’s not that you’re trying to make them calmer, it’s just that you’re working on rebalancing everything. By rebalancing the gut flora, then you’re going to get a better balance of neurotransmitters. You’re going to feel better. Your mood is going to improve.
In that sense, you’ve given them some resilience in their life that they didn’t know they actually had or they didn’t know they had the ability to leverage their own natural healing powers to make their bodies and their brains basically more resilient.
I think it’s been a great chat on the microbiome and a little tour of the body and how the microbiome affects not only your gut, but also all the rest parts of your body. Your book is called Happy Gut. Your website is HappyGutLife.com. Tell us what else you have coming up in the near future.
It’s a lot of things. I’m speaking for the Health Coach Institute at their live event coming up in May. I’m going to be at the Navel Expo here in New York City giving a lecture. It’s going to a TED-style talk. I’m starting to think about my next book, we’ll see. The podcast sprint, that’s still in the works for me. I am working on manifesting what I’m going to call The Gut Smart Podcast.
We look forward to The Gut Smart Podcast. Hopefully, that’ll come around. I want to thank Dr. Vincent Pedre for being on The Healing Pain Podcast, talking about the microbiome and the gut. You can check him out at HappyGutLife.com. As usual, stay connected each week to DrJoeTatta.com/podcast for updates on the podcast and on the website. Thank you very much. We’ll see you next week.
About Dr. Vincent Pedre, MD
Dr. Vincent M. Pedre is the Medical Director of Pedre Integrative Health and Founder of Dr. Pedre Wellness, Medical Advisor to two health-tech start-ups, MBODY360 and Fullscript, in private practice in New York City since 2004. He is a Clinical Instructor in Medicine at the Mount Sinai School of Medicine, also certified in yoga and Medical Acupuncture. He believes the gut is the gateway towards excellent health. For this reason, he wrote the book, “Happy Gut—The Cleansing Program To Help You Lose Weight, Gain Energy and Eliminate Pain”—which helps people resolve their gut-related health issues.
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