Adapted from episode 136 of The Perfect Stool podcast with Vincent Pedre, MD, Board-Certified Internist in private practice in New York City, Medical Director of Pedre Integrative Health and President of Dr. Pedre Wellness, and Lindsey Parsons, EdD, and edited for readability.
Lindsey:
So today we’re going to be focusing on difficult cases of reflux and gastritis. So can we start by just getting definitions of what those two conditions are and what symptoms you might have if you have either or both?
Dr. Vincent Pedre:
Yeah, a lot of times they can overlap in terms of symptoms, but someone who has acid reflux, technically, is having some acid from the stomach coming up through the lower esophageal sphincter, which is the little muscle that closes the esophagus when you swallow, to make sure that acid doesn’t come up. And the acid is somehow making its way up into the esophagus, and that usually causes that sensation that people get of heartburn, usually here in the chest, but sometimes they’ll feel it in the throat too. They may wake up in the middle of the morning or the next day and feel like they’ve got some acid in their throat, or they might actually have a little bit of a hoarse voice from acid refluxing back and getting onto their vocal cords. Or they might actually wake up with some mucus in the morning, and all these could be signs of acid reflux.
Obviously, sometimes, you know, in the body, there are symptoms that tend to converge together. So having throat symptoms could also be post-nasal drip. You always have to be thinking that things could be coming from different directions, and gastritis is basically an inflammation of the lining of the stomach, which can come from a variety of reasons. A lot of times it can be, actually, deficiency of certain micronutrients, like zinc and l-carnosine that are necessary for the health of the stomach lining, not enough mucus production, and unfortunately, a lot of times, I think we’ll get into this, these issues are treated with acid lowering medications like PPIs. Now, the difference with gastritis is that you won’t get the heartburn symptoms, but you may get some feelings of upset stomach, sour stomach, maybe food doesn’t sit well in the stomach. A lot of people will have chronic gastritis and probably not know that they have it, and it’s usually an incidental finding on an endoscopy or an imaging study where they look down through your esophagus with a camera and a tube and take pictures of the stomach. So a lot of times it will be found, but the person isn’t necessarily aware that they have gastritis.
Lindsey:
I’ve also had clients, though, who have real, burning sensations in their stomach.
Dr. Vincent Pedre:
Yeah, which could be an ulcer, or could also be a symptom of gastritis, as well.
Lindsey:
Yeah. And obviously an ulcer is pretty serious. So what would alert someone that they have maybe an ulcer and they should be getting some immediate medical attention?
Dr. Vincent Pedre:
Sometimes it’s just the degree of the symptom, the severity of the symptom, the time course of how the symptom changes over time. Usually, an ulcer, if you’re not doing anything to make it better, it’s going to continue to get worse and worse. It’s going to get more and more intense over time, whereas usually gastritis kind of lingers in the background. It doesn’t necessarily get really, really sharp in the way that an ulcer can get. And then you also want to look at other behaviors, like, did the person recently hurt their ankle, or something like that, and they’re taking over the counter ibuprofen, and they thought that it was safe, and it was okay to take without a prescription. And then two weeks in, they start getting stomach pains, and they’re not sure, well, why am I having stomach pains now?
Lindsey:
Yeah, I had that happen. I had terrible sciatica, and really, there was nothing that would manage it except ibuprofen. And it got to the point where I was like, I’m giving myself an ulcer; that has to stop. I’m going to have to figure out what else to do.
Dr. Vincent Pedre:
Yeah, people have to be really careful with that. And you have to also be really careful because you might be taking ibuprofen. And then, because all of these medications are available over the counter, you start feeling some stomach pain. So now you go and get an over the counter anti-acid medication, whether it’s Pepcid or some sort of PPI that are now available over the counter, and you’re self-treating, but without really knowing what’s going on underneath, and you’ve got to make sure that you’re stopping what is causing the underlying problem, which in that case is, could be Naprosyn, could be ibuprofen, could be any of the NSAIDs.
Lindsey:
Right. Yeah. So for me, you know, as a gut health coach and someone who deals with gut health issues, there are some obvious reasons for reflux and gastritis, like SIBO, which would normally be accompanied by bloating or loose stool, diarrhea, constipation; and then H. pylori, which is easy enough to test for and correct. But I also have a number of clients who either have relatively low levels of H. pylori, so like on a PCR test, it shows below reference ranges by a good degree. You know, it’s something to the second power versus to the third power, which is the reference range (one to the third).
Dr. Vincent Pedre:
I’m even skeptical about those reference ranges when-
Lindsey:
oh, okay
Dr. Vincent Pedre:
-it comes to H. pylori, I think that we have to be really careful with the H. pylori test in some of these PCR tests, and-
Lindsey:
you think like over killing it? or under-killing it?
Dr. Vincent Pedre:
I think we’re over diagnosing, and we may be over treating H. pylori. H. Pylori is very controversial, because it does exist in certain individuals without causing any symptoms.
Lindsey:
Right, right.
Dr. Vincent Pedre:
It doesn’t cause gastritis; it doesn’t lead to ulcers. And the question is, in a patient that might show up with H. pylori, do you still treat them for H. pylori, meaning, you’re putting them under a regimen that’s going to take time, effort, it’s going to affect quality of life, it’s going to add some extra stress, or do you just leave it be? And I think I’m very careful with some of these PCR tests saying that “you’re out of range” with H. pylori, I always want to go back to the patient first. What symptoms are they having? Does it correlate with H. pylori? And I like to do a test to determine whether they do actually have active H. pylori infection with either the stool antigen or a breath test.
Lindsey:
Mhm.
Dr. Vincent Pedre:
So I think it’s important when it comes to H. pylori, I think the decision tree has to be a bit more careful than just using a tool like the GI map, for example.
Lindsey:
Right, right. What I was getting at, though, was that you might have somebody who doesn’t seem to show, what I would believe, is a problematic H. pylori, because the reference range is low, there’s no virulence factors, or their H. pylori isn’t even existent, but they still have that burning and the gastritis in the stomach. So what reasons, beyond SIBO and H. pylori, might there be for that? I guess we’ve talked through ibuprofen use or NSAID use. What other possible reasons are there for the reflux or gastritis?
Dr. Vincent Pedre:
Yeah, we have to think, first of all, of hypochlorhydria, so inadequate production of stomach acid, which could be in conjunction with gastritis or just loss of the mucus barrier, not enough production of the mucus as well as hydrogen, which is dependent on zinc. So that’s why zinc l-carnosine becomes a very important nutrient in treating these patients, because a lot of them are actually zinc deficient, and that’s partly why they’re having these symptoms. When you have low stomach acid, it can do the opposite of what you would think. So you’re wondering, well, if someone has low stomach acid, why are they going to get reflux or heartburn? That doesn’t make a lot of sense. The issue is that when you have less acid production in the stomach, food isn’t going to break down so easily, and as your body detects that, it’s trying to break that food down by producing more gastric juice, but that gastric juice maybe is at a higher pH, it doesn’t have both the strength and also the proper pH for the proteases to work at their best, most efficient. And as your stomach fills up, it’s very likely that some of that gastric juice is going to spill up into the esophagus and give that heartburn sensation.
It also can be dependent on when the person is eating. It’s so, so important to ask our patients, what time are you eating dinner? Especially, how long after dinner do you lie down? So it’s not good to lie down – regardless of what’s going on in the stomach – within a few minutes of eating or eat dinner and then an hour later go to bed because digestion isn’t finished, there’s still food in the stomach. It’s very likely that, even if you don’t have low stomach acid, you don’t have a propensity to reflux, just by the pressure of the food and lying back with gravity, you’re going to get some reflux symptoms.
Lindsey:
And what would cause the loss of the mucous barrier? Is that zinc deficiency, or are there other reasons for that?
Dr. Vincent Pedre:
It partly can be zinc. We see it also with H. pylori infection; the barrier starts to break down, and then it becomes easy for the lining to become inflamed or even eroded and lead to an ulcer. More rarely, this would be a very rare case, where you’re getting bile reflux into the stomach, and that could also cause these heartburn-like symptoms, you know, where people feel like they might have an ulcer, they have gastritis, but it’s actually bile moving in the wrong direction.
Lindsey:
Yeah, so we’ve talked a little bit about causes for reflux that were not, sort of, the obvious couple things. What about causes for gastritis that beyond the obvious?
Dr. Vincent Pedre:
I think going back to nutrient deficiencies, you have to think about, basically, doing a very comprehensive look at the person’s micronutrient profile as well as their ability to heal. So things like vitamin C, other nutrients that are very important for healing, like I said, zinc, even thyroid function, like, if a person is slow healing, thinking about do they have hypothyroidism? And also, let’s say, a less obvious one is going to be vagal nerve dysfunction, which really comes from stress. So people are walking around stressed and in fight or flight, which shuts down the vagus nerve. The vagus nerve is also needed, very important, to signal and trigger gastric acid production, as well as protection of the lining with mucus, as well as the production of digestive enzymes. So if we lose vagal tone, that also increases the risk for these things, as well as dysbiosis, although it’s not as important in the stomach, the stomach is not a very microbiome-rich environment like the large intestine and the small bowel, with the large intestine being the biggest reservoir for the microbiome.
Lindsey:
Yeah, and so what can people do to restore their vagus nerve function?
Dr. Vincent Pedre:
Oh, I love this! One of my favorite, favorite things to talk about. I mean, first of all, it’s about really making space for mindfulness and for relaxation. Just breath work, bringing up the diaphragm, doing deep diaphragmatic breathing, is super important. Most people, when I ask them to take a deep breath, they’re breathing up here, you know, so, and I’m sure if you see your clients, you ask them to take a deep breath, they probably go like this. They’re breathing all up here, but they’re not really breathing down here with the diaphragm. And that’s a huge problem for a lot of people, and people don’t realize that stress actually causes them to constrict their belly, even just the rib cage gets constricted. And sometimes you have to go in and massage the edges of the diaphragm to kind of loosen up some of the fascia so that you can then get an easier, deeper breath, even just by massaging here and up and down the rib cage and even around here, because the neck gets so tight from people clenching their jaw at night. So many of my patients, I see that they’re clenchers; you can see the bottom incisors are worn away. They have neck pain, but it’s coming from the fact that they’re clenching their jaw. So, even just loosening the jaw, loosening some of the neck muscles, opening this up, just massaging along the edge of the diaphragm, so you can take a really deep breath, because then those stretch receptors in the lungs are going to then stimulate activation of the ventral vagus nerve.
We can do it other ways too, because the vagus comes here down on either side of the vocal cords, so things like singing, gargling, humming, all of these things are really good for activating that vagus nerve and calming the body. But we also know that having a balanced gut microbiome also helps to activate the vagus nerve and that interface, because the vagus enervates the entire intestine, and part of the way that the vagus is sending signals back to the brain is through serotonin receptors. And if you have a disordered gut microbiome, you’re not going to get as much serotonin production. If your gut lining is disturbed, then the enteroendocrine cells, which are sparsely, they’re almost like stars in the night sky; they’re interspersed all over the intestine, and they’re also producing serotonin and helping to stimulate the vagus nerve. But if this is the disorder, then that’s also going to affect vagal tone, and then that has a downstream effect on the entire gut. I think it’s one of the most important issues that we need to never forget to address in our patients, because we can get so lost on the mechanics, and supplements, diet and forget the critical importance of the vagus nerve.
Lindsey:
Yeah, yeah, I’ve been doing breathwork every night for the last, I don’t know, three or four months with my husband and he mentioned that since we’ve been doing it, he’s taking much deeper breaths; that before he was breathing very shallowly. I’m sure that all upper chest kind of breathing, and I was excited to hear about that.
Dr. Vincent Pedre:
Yeah, it keeps you more in that fight or flight response. It’s almost like people are wearing an armor, like if you’re stressed, you don’t even realize it. It’s subconscious. But you put on this armor, and the armor is in the form of you bringing your chest wall in, and you take shallower breaths. I always think of it, like I tell a patient, imagine walking out into a field, a big green field in the countryside, where the views are all the way to the horizon, and imagine what it is to take a breath there. You know, you feel this expansiveness. It’s easier to take a deep breath, because you feel more space and you don’t feel attacked by being in a city, or even just by the stress that you carry with you at all times.
So what about Crohn’s disease? Could that manifest in the stomach or the esophagus?
Crohn’s is a systemic disease that is not limited only to the intestines. It’s actually an autoimmune disease that can even be manifest in the eyes, for example.
Lindsey:
So people who are having extreme pain in their stomach or esophagus and don’t seem to have all these other things could, it could be Crohn’s.
Dr. Vincent Pedre:
I mean, it would be rare, because you’re always going to have Crohn’s also in the intestines, in the small intestine and possibly the large intestine. So it would be, it would have to be a really extreme case where it’s spread that far. But most of the time it’s more- you’ll find it more in the small intestine or large intestine. And again, it’s one of those things, you know, we give it a name, but the name doesn’t really say what the true underlying cause is.
Lindsey:
Right, right. Okay, so I have a couple of clients whose gastritis is so bad that they came to me already having been on very extreme low acid diets, and/or they’ve already been on PPIs long term. So, I’m wondering if there’s ever the case for those kind of diets, or is it more about finding out the root cause of the issue and then correcting it?
Dr. Vincent Pedre:
Well, I’m always going to say it’s about finding the root cause. And yeah, I mean, if your house is on fire, you don’t want to throw more wood into the house. So if things are really on fire in your in your stomach, you have to be really careful about eating the the big triggers like chocolate, mint, fried foods, acidic juices, tomato sauces, wine, all those things are going to be big triggers. But what I found is that, in contrast to the Western medical model, where we would take that person and we would just say, Well, you have these symptoms, here, take this medication, and now you can drink your wine, now you can eat these foods, they won’t bother you anymore, but the minute they stop the medication, those foods are going to bother them. And what I found is that, when you work on the root cause, the things that we’ve been talking about, like improving gastric acid production, improving the mucus layer, using different things like leaky gut formulas, formulas that have zinc carnosine, slippery elm bark, marshmallow root extract, all these things that help to heal and seal the gut lining, and change the behavior, make sure they’re eating meals properly at the right time of day, not eating too late at night.
As you heal the root cause, the person then can start eating more “normally”, and can actually enjoy things that they were not able to enjoy, because now you’ve healed the gut. So maybe if they want to have that glass of wine once a week out with their friends, they can do it, and now they’re not going to pay the price in the same way. So I think it takes a little bit more work to unravel the root cause, and it takes a bit of introspection, looking at self, looking at behaviors, looking at how the person is holding stress, and even today, looking at dietary patterns. So today, I had a patient who suffers from intermittent reflux, and she was having dinner, but then having a big bowl of fruit right after she had just finished eating dinner. And having fruit right after having a big meal with protein, the fruit is going to sit there and it’s going to start fermenting and it’s going to produce gas, and very likely, it’s going to cause some burping and reflux. So sometimes you have to tease out the little behaviors that just require repositioning, like, okay, let’s not eat fruit right after finishing dinner, especially fruits that tend to ferment, like watermelon, not a good idea.
Lindsey:
Yeah. So with a lot of clients, when I’m doing their initial intake, they seem hesitant to admit they drink coffee like they think I’m immediately going to say, you need to give up that coffee. And I’m kind of agnostic on coffee, honestly.
Dr. Vincent Pedre:
People hold on to their coffee.
Oh yeah, exactly. But I mean, I’m agnostic about it, because I know it’s got some health benefits, and I know it’s a good bitter which promotes bile flow. But I’m not, personally, a coffee drinker, because I just don’t like the taste, although I love the smell. So is coffee a healthy food, and is it a possible contributing factor to reflex or gastritis?
It can be both. I’m going to say for someone who’s whose house is on fire, coffee can add a bit of fire to that house, especially if the coffee is more bitter, if it’s more acidic, if it’s got a high level of caffeine, all of that can be a trigger for more potential reflux. And also it’s depending on how the person has the coffee and whether it’s being drunk on an empty stomach, if they already have some food in the stomach. So there’s always mitigating factors that make things a bit confusing for people, because they think, well, one time I drink it, I’m fine, another time I drink it, I’m not fine. And, really, it has to do with the individual circumstances that surround every behavior and how you do things. So I’m always getting very granular on, what did you do in that moment? You know? Was it on an empty stomach? Had you eaten something else? I think it’s very important.
But the thing to know is that a good coffee that’s free of toxins, free of pesticides, free of mycotoxins, that has polyphenols or antioxidants like chlorogenic acid, coffee has a lot of potential health benefits, not just for the gut microbiome, but also for the gut-brain access and for brain function. So there’s a lot of really great benefits for coffee. And I think the truth is the majority of the world drinks coffee every day. I think it’s like a billion cups of coffee are served every single day, and at least 130 million American adults drink a cup of coffee every single day. So it’s a habit that’s not going away. It’s just the habit that we need to look at. Well, what are the other things that surround it that could also make it more unhealthy or healthier?
Lindsey:
Yeah, yeah. I know there was the big craze around keto coffee with MCT oil and all that stuff for a while. I don’t know if people are still doing that. My sister got into this pouring heavy cream into her coffee. And you know, we have family hypercholesteremia, like, listen, you were doing a keto diet, and the heavy cream might have been okay, but you’re now eating carbs. You can’t keep pouring like half a cup of heavy cream into your coffee and be eating all the carbs, like it’s one or the other.
Dr. Vincent Pedre:
Yeah, no, because then the carbs are going to turn on the inflammation, you know, and then it can make your cholesterol inflammatory. It’s really the carbs and the sugar and all that. Yeah, that was a big craze for a while. I’m trying to think of, like, how to, you know, there was the Bulletproof Coffee craze, right? Like, how to come up with another version of that. I mean, I know I have my Happy Gut Coffee (10% off with code perfectstool10), but calling it Happy Gut Coffee and having some other recipe or something that makes it gut friendly,
Lindsey:
Yeah. What do you like to do? Do you drink your coffee black, or you like something in it?
Dr. Vincent Pedre:
It depends on what coffee. I can definitely drink my Happy Gut Coffee black and, because it’s a dark roast and it’s very low acid and it has no bitterness, I actually like to add for my gut health, I tend to put in my coffee SBIs, Serum-Derived Bovine Immunoglobulins. So I put SBI powder, and then I also add some collagen peptides into the coffee, and then I may or may not add some almond milk as well. Always dairy-free.
Lindsey:
Okay, so how did you get the bitterness out of your coffee? I’m wondering.
Dr. Vincent Pedre:
It’s just what happens with the roasting process. You want to make sure that-
Lindsey:
The lighter roast? You said, No, it’s a dark roast.
Dr. Vincent Pedre:
When the beans are roasted, you have to make sure that they don’t get burnt. They have to be roasted exactly to perfection. That lowers the bitterness, lowers the acidity. It actually makes it a little bit lower caffeine as well. So for someone like me, who is actually a slow caffeine metabolizer, so I can’t drink a cup of coffee in the afternoon and have a good rest that night. It’s going to affect my sleep. But for someone like me, that’s a slow metabolizer, and usually I avoid drinking coffee, my Happy Gut Coffee does not cause that jitteriness that I get with some other coffees. And I think probably it’s a combination of things. It’s free of the toxins, no mycotoxins, no pesticides. And I think just being a much cleaner bean has a different effect.
Lindsey:
Okay, well, new, unrelated topic, but one I know that you have some expertise on. There’s been a lot of info in the news lately about not just microplastics, but now nanoplastics. That makes me feel like they’re impossible to avoid unless I grow all my own food and live in a cave. So how do these micro and nano plastics affect the gut, do we really know, and how can we avoid them?
Dr. Vincent Pedre:
This is a scary thing, right? Because when you go to the supermarket, a huge majority of the foods are stored with plastic, right? They’re in plastic containers. They have plastic wrap over them, and we’ve been doing this for ages. Well, maybe not for ages, because I feel like this has become more prominent since the late 70s into the 80s, having food convenience. And the thing is that these microplastics get everywhere, and we’re starting to find that they can actually accumulate in the gut, and not that this is a cause and effect, but there was a study that showed that people who had inflammatory bowel disease had higher concentrations of microplastics in their gut.
Now, association is not necessarily saying that one thing caused the other, but it does start to beg the question, is there some relationship between inflammatory bowel disease, when there’s no other obvious cause, and exposure to microplastics, from plastic water bottles, from plastic food storage, from, I mean, people who used to heat up easy meals in the microwave that come in plastic containers, not thinking about how the micro plastics get into the food. And we know that studies, for example, there was a study done on zebrafish that showed that microplastics cause changes in their gut microbiome, and the change was towards more harmful bacteria, bacteria that cause inflammation and actually also reduced mucus secretion, which is part of what protects the lining of the entire intestine is the mucus layer. It’s very, very thin, but it’s super important to keep the bacteria and other harmful substances away from the lining of the stomach. So we also know from another study in mice that microplastics were connected with increased body weight and changes in their lipid profile, and also cause elevation in liver enzymes.
So microplastics are doing something. And, I think if we try to think that they’re not, and just think, like, this is just way out there. Like, I mean, when I went to medical school, we weren’t talking about plastics. We didn’t talk about how plastics could have a connection with autoimmunity, like dysregulation of the immune system, Bisphenol A, no one was talking about that. And now here, suddenly we have to think about nanoplastics, like all these microplastics that are getting everywhere, and all the plastic in the ocean, the plastic that’s getting into fish. And it can get a little bit overwhelming, right? Like, yeah, what do we do?
And then the other place that’s worrisome, and partly why I’m trying to get people to almost step back in time and make coffee in a more traditional way, whether it’s a French press or doing a pour over with a filter, instead of those easy pods where you wake up and you can just flip the switch, and then your coffee is done in a few seconds, but that hot water is going through the pod that’s lined with plastic, and now you’re getting micro plastics in your coffee and drinking that, or when you go and you pick up your coffee to go from any place, they’re giving you, not a Styrofoam cup, but a cardboard cup, but the inside is often lined with plastic. So when it touches that hot water, you’re getting microplastics into your body. And I think the research now, what it’s showing us, is that we can’t ignore this. As if we needed another problem to pay attention to; another mitigator of disease for humanity. Because this one actually, when I wrote this article on my blog post on Happy Gut Life, I was really depressed by the end of it, because I thought, okay, but what do we do?
Lindsey:
Yeah.
Dr. Vincent Pedre:
Like, is humanity doomed at this point? Are we too far into plastics that there is no way back? And I know there are things – look, you can’t easily change what’s happening at the macro level, but you can make choices on how you choose to live at your level, like even just making sure that you’re drinking from a glass container, not from a plastic water bottle, or not using the convenience of plastic water bottles at the office instead of drinking filtered water that you bring from home. A lot of people do that. Or, just going to the farmers market with your own big fabric tote bag, and you put all the vegetables in there without using any plastic, so that you’re avoiding that contact with plastic. You know there, are choices that we can make every day as individuals that could help us avoid some of these exposure to plastics, and even just like thinking about the type of clothes that you buy because there’s polyamide and clothes that’s also plastic that’s used in textiles, or even filtering the air to make sure that microplastics that might be found floating in the air that you breathe are getting filtered out, making sure you’re drinking clean water. This is the-
Lindsey:
Let me stop you there, because the water is like the one that I’m sort of like, ah, what to do about this? Because I’ve got, like, the best water filter you can have in the fridge, right? Like, I’ve got this Zero Water, and it filters almost everything out, but it’s a plastic bottle that it’s sitting in! Now, I know it’s not the worst kind of plastic bottle. I assume it’s the better kind of plastic bottle, but it’s still in the plastic bottle. So it’s like, did I screw up? Do I need to go out and get a glass one? I don’t even know if they sell such things!
Dr. Vincent Pedre:
Or acrylic. That might be safer. Um, yeah, no, I agree.
Lindsey:
I don’t actually know what the substance is.
Dr. Vincent Pedre:
I agree that it’s overwhelming. You know what we do. The thing to note, though, is that it’s extremes of temperature that’s going to extract the plastics more or any sort of mechanical effect. So technically, the plastics going to, more likely, leach microplastics from big temperature changes or from being exposed to heat. So even just not exposing it to heat. That’s what’s so scary to me about plastic water bottles, because you don’t know how many temperature changes they’ve gone through as they’ve been transported from the source to where they’re finally sitting at the store. They’ve probably been in the hot truck somewhere at some point, and that heat makes them leach plastic into the water.
Lindsey:
Yeah, yeah, I stopped using those. The only one that I was using was I was getting Fiji water, because I know that that chelates aluminum, and so I was using that. And I’m just like, forget it. I’m not doing that anymore, unless I find some aluminum in my urine or blood or, you know, I’m not goofing around anymore because I had no aluminum. I was good. And I stopped. I guess the other thing I’ve done is I went out and I bought tons of those glass containers because it kept being, like, there was still some plastic in the cupboard, and we’d still end up using it because we just didn’t quite have enough of the glass ones. I just bought, like, reams of glass containers.
Dr. Vincent Pedre:
Meaning, that’s for food storage, right? Like making sure to store your food in glass containers. Because, I mean, the the scary thing about the study is that the plastic, the microplastics, accumulate in the gut, and then they don’t really have a place to go, you know? So you wonder if it’s another underlying root cause that we’re not paying attention to when it comes to inflammatory bowel diseases like Crohn’s and Ulcerative Colitis. Obviously, there’s- in things like that- there’s always multiple root causes, and you have to look at the additive sum of different things and control the factors that you can control and otherwise do your best.
Lindsey:
Yeah, yeah. The other thing I stopped doing is, like, even the plastic bags. I always tried to be good for the planet and wash out my plastic bags and reuse them. And now I’m just, like, not so much, like, one or two uses, and then it’s going to go in the garbage. Like, I’m not going to keep beating these things to death because, inevitably, you have to store some things in plastic bags. Like, you can’t fit a leftover loaf of bread in a glass container. So, you know, there’s some inevitable uses of plastic, I think. Any nuggets of wisdom for people who don’t have terrible gut health, meaning no huge issues, maybe occasionally they have a loose stool, occasionally they’re constipated, occasional indigestion if they’ve eaten the wrong thing, but normally they’re pretty good. Like, what’s a good gut health plan for the average person?
Dr. Vincent Pedre:
Let’s start with the – I mean, this is even just for general health purposes – everyone can always avoid processed foods. Try to avoid excess exposure to seed oils, inflammatory oils, which are not good for the gut. Try to avoid exposure to genetically modified foods, those can be problematic for the gut. Try to avoid excessive exposure to foods that have high levels of pesticides. You can look at the Environmental Working Group website, and I actually included the chart in my last book, the Gut Smart Protocol*. So look at the Dirty Dozen and the Clean 15. Those are the lists of foods that have the highest amount of pesticides and the ones that have the least amount of pesticides. So if you’re like everybody nowadays, you know; food costs have gone up; you want to be on a budget with your food, but you also want to be healthy; buy organic any of the foods that are in the Dirty Dozen, and you can be a little more lenient with not having to be strictly organic with the foods that are in the Clean 15; that at least allows you to spread your food dollars wisely, and then, of course-
Lindsey:
-You’ve got check that each year, because they change, like sometimes like, bottom goes to the top, or vice versa.
Dr. Vincent Pedre:
Yeah, exactly. Every year you have to go to the website and see what their updated list is, and then sugar. Sugar is a big one. We know that sugar is one of the leading causes of disease, chronic disease, not just of the gut, but metabolic insulin resistance, diabetes, heart disease, all of that is connected to excessive exposure to sugar. So lowering your sugar intake in whatever ways you can. Not just obvious sugar, like cane sugar, like desserts, but also hidden sugars in drinks, or, like, putting syrups and things, like if you go get a fancy coffee. Or, also, eating too many refined carbohydrates. So even just starting at that level and eating more whole foods in general, that can be very helpful. I have varying opinions on whether people with, well, I guess we can talk about people with more severe gut issues. So that would be a different question.
Lindsey:
Okay, well that seems like a good plan for pretty much everybody. And what’s a good gut plan for people who feel like they may be inflamed or have markers of inflammation, maybe not that they have gut symptoms, but they have like, elevated hsCRP, or maybe appear to be at the beginning of autoimmunity, but no obvious gut health issues.
Dr. Vincent Pedre:
Yeah, and these people – I would still, in a person like that, take them and do stool PCR testing and look for inflammatory markers, because even if the person doesn’t have gut symptoms, if they’re already showing up with some signs of autoimmunity, it’s very possible that they’re already brewing some imbalances, dysbiosis, maybe some harmful back gut bacteria. They might have parasites, they might have Blastocystis, they might have yeast overgrowth. I’ve seen that in people that actually report no symptoms whatsoever in their gut. So I think that’s a very important myth to dispel, is that in order to have a gut issue, you have to have gut symptoms. You could be walking around feeling like everything is fine here, and yet actually have some pretty big imbalances in there that, maybe because you’re not so aware of it.
It could be that you’re distracted by symptoms in other parts of your body that you don’t realize what’s going on there, and then, depending on what’s happening in the gut, my diet plans could range from the extreme of actually putting someone on a very close to carnivore-like diet to be able to lower inflammation, heal the gut. Especially if they’ve got a lot of issues with digestion or low digestive function, not enough enzymes, it’s going to be very hard to break down a lot of vegetable proteins. Or having them, if they want to have vegetables, but no raw just cooked. Thinking like this is an intermediate diet for someone whose gut is not quite ready to have raw foods yet, when they eat a salad, they feel horrible, they feel really sick. That shows that there’s a lot of gut dysfunction happening. So for someone like that, making sure that their Omega three levels are optimized, whether it’s through supplementation, through eating Omega-3 rich foods. For me, the preference would be wild salmon or sardines. Like those types of Omega-3s are just much more bioavailable, much more readily used by the body than plant sources. And the plant sources can be harsh on the gut for some people. It’s always a hard conversation with people who are more plant-focused to get them to see that sometimes too many plants could actually be harmful to the gut.
Lindsey:
Yeah, no. It’s funny because I was more of, like, philosophically, more of a kind of paleo person. I can’t say that’s how I eat, because I don’t have the self-control to not eat other grains, and I don’t seem to have the need to be that strict for my health. But I see people who have high beta glucuronidase, and I’m like, I’m sorry, you’re going to have to eat like, a vegetarian diet for a while, or they have, like, hydrogen sulfide SIBO and I’m like, yeah, you need to go off meat completely. And then I have other people who are, you know, already vegetarians or vegans, and they’ve got methane, high methane, you know, and IMO, and I’m like, I’m sorry, you’re going to have to start, like, eating some meat, because I don’t know how you’re going to get protein without constipating yourself. So, I mean, now I’m just completely agnostic about diet. I’m like, it depends on what’s going on in their gut completely.
Dr. Vincent Pedre:
Yeah, I totally agree with that. And then, obviously, matching it with, and sort of meeting somewhere in the middle with the person’s food preferences, right?
Lindsey:
Of course, and inevitably that comes to bear.
Dr. Vincent Pedre:
Yeah, because you might think that for a vegan, the best diet would actually be a meat-eating diet, but they’re not ready to make that jump and it would be, like, the worst thing for them, psychologically, mentally, it might create a lot of stress, but I try to meet people like that halfway and see like, Okay, well, if we’re not going to get to meat, could we compromise with fish? Or is there one meat that you would be okay with eating, because oftentimes it does make the gut better.
Lindsey:
Yeah.
Dr. Vincent Pedre:
Yeah, and I actually had a patient like that last week who was eating a lot of substitute vegetable proteins-
Lindsey:
Oh yeah.
Dr. Vincent Pedre:
-to be able to, you know, to be able to get enough protein in her diet, but she was using one, one was like a mushroom protein, like chicken substitute, but it did have wheat and gluten in it. And then the other one that she was eating a lot of was seitan. She was having incredible gut pain, bloating, distension, constipation, and I just think, like when you’re making- if you’ve ever seen somebody make bread and you stretch it, that gluten is what makes the bread so sticky and gives bread that consistency. But now you’re eating that concentrated in a vegetable protein substitute, and all of that stuff forms this big sticky mass in your intestines. It’s very hard for it to move, for you to poop it out. Your body doesn’t have the enzyme strength to break it down, so it can cause a lot of gut disruption for people, but it’s hard convincing someone who is either was raised vegetarian or philosophically vegetarian that, look, eating some meat is actually going to make your gut better.
Lindsey:
Yeah, yeah, yeah. And sometimes you have to get in there and do that amino acid profile and show them they’re protein deficient and that they really have to figure that out. And maybe it’s a lot of protein powders at the end of the day, if that’s what they’re willing to do, but-
Dr. Vincent Pedre:
Even that can be problematic. I’ve had people have reactions to pea protein as well, which is one of the biggest ones used in these vegan protein powders. So, I will say it’s rare, but I’ve seen it enough to note that, okay, we can’t say that one protein powder is perfect for everyone, even pea protein, which is supposed to be hypoallergenic, some people may react to it. Now, if you’re listening to this and you react to a protein powder, you also have to think you’ve got some work to do on your gut. If you’re reacting to protein, that means maybe your stomach acid is low, you’re not breaking down protein enough. Maybe you have pancreatic insufficiency. You’ve got leaky gut. So there’s other work that needs to be done.
Lindsey:
Yeah, and I will tell you, because I just got some pea protein powder myself, that it tastes like peas. It’s not great in a smoothie. Like, I’ve discovered that. I’m sure there’s more combined ones that are better, which is probably- But the added artificial sweeteners are so repulsive, like the added monk fruit, I’m just like, blech I can’t take it.
Dr. Vincent Pedre:
That’s the other issue with them. I did find, when I was working with a company and we were developing a protein powder, and we wanted a vegan protein powder, but we were looking for flavor, texture, consistency. We were experimenting with chickpea protein. But the thing is, with chickpea protein, if you ever made a chickpea pasta-
Lindsey:
I have.
Dr. Vincent Pedre:
So when you make the chickpea pasta, after it sits for a while, it starts to stick together. It’s very, very sticky. Same thing happens with the chickpea protein in a smoothie. It starts to all congeal together. So we had actually figured out a combination of pea and chickpea protein, where, with the right ratio, the chickpea gave the smoothie a creamy texture, while not using only chickpea protein allowed it to have a smooth consistency and not congeal and get really sticky or almost like pudding.
Lindsey:
And did you have a protein powder in your Happy Gut line?
Dr. Vincent Pedre:
We do have ones that have pea protein. It is a micronized pea protein, so it’s broken down. It’s much easier to digest. But we don’t have one that mixes in the chickpea protein, just because of, still, the complications with figuring out the right ratio of the chickpea protein, and still, look, the pea protein, by and large, is tolerated by the majority of people. I think there’s like 2 to 5% of people that come back and they say that they have some sort of reaction to the pea protein.
Lindsey:
Yeah. Okay. Well, anyway, that was all interesting stuff. So, where can people find you and your coffee and your other happy gut products? And I know there’s also a discount code for my listeners.
Dr. Vincent Pedre:
Yes, they can go to happygutcoffee.com and that’ll take them to the website. They can check out the clean, Dark Roast that’s toxin free, low acid, and I like to say never bitter, because it is quite smooth. And everybody’s going to have a discount code for 10% off the store by using the code perfectstool10.
Lindsey:
Okay, awesome! Appreciate that. Any parting words before we sign off?
Dr. Vincent Pedre:
I feel like we gave a lot of really great tidbits of information for people who are listening and suffering from these types of issues. I think this was a really practical episode that people are probably going to want to go back and listen to it again and take notes and maybe go and speak to their health practitioner and say, hey, you know, maybe we should think about this this way. So I hope that anyone who listens to this is inspired to always dig deeper and not be conformed to just taking a medication to treat a symptom, to look for what is the underlying root causes, and is there a way to treat that in a way that will create long, lasting relief.
So if you’re dealing with low stomach acid or gut health issues of any type and need some help, I see individual clients to help them resolve their digestive issues and you’re welcome to set up a free, 30-minute breakthrough session to see if you’d like to work with me. I also have my own two products, Tributyrin-Max, which is particularly helpful for loose stool and diarrhea as it slows your motility and firms up your stool, and SBI powder, which is an all around gut pathogen binder, which is super safe and won’t harm beneficial bacteria, and is usually the first line of treatment I educate my clients about in order to avoid stronger antimicrobial herbs.
*Product and dispensary links are affiliate links for which I’ll receive a commission. Thanks for your support of the podcast by using these links. As an Amazon Associate, I earn from qualifying purchases.