Adapted from episode 98 of The Perfect Stool Podcast and edited for readability with Vincent M. Pedre, MD, Medical Director of Pedre Integrative Health and President of Dr. Pedre Wellness.
Lindsey:
Before we launch into today’s topic, why don’t you give us a short synopsis of your own gut healing journey?
Dr. Pedre:
So that goes back to when I was a kid. As far as I can remember, I had a very sensitive stomach. I actually suffered from pretty severe constipation when I was a child. I think it was mainly due to not such a great diet; it was pretty devoid of vegetables. And I hated eating salad greens, so any insoluble fiber, that was deficient in my diet. But it was really in my early teen years where my gut started being very problematic. And coincidentally, around the same time, probably dating to the age of 10, maybe as early as eight years old, it was very common to go to the doctor with a cold, with an upper respiratory infection and be prescribed an antibiotic. So I don’t think I ever went to the doctor without having left with an antibiotic prescription. That probably happened more than once per year, from the age of 10 all the way through my teenage years.
I remember at times, not being able to recover from an infection like one time I had a severe bronchitis, which almost felt like an ammonia, and I wasn’t responding to the antibiotics. My mom would take me to the clinic, where I doubt that this is done anymore. This was back in the 80s. They would give me an injection of gamma globulins, so pooled globulins from the blood supply. And after I got those gamma globulins, I always felt better within a day. So it was almost like my immune system wasn’t working properly. And the pediatrician would say I need to be on a multivitamin and gave me these big horse pill multivitamins that I had to take. But that didn’t help me not get sick as often. And it really took me about two decades to fully understand. It’s part of what motivated me to become a doctor: Why do I get sick so often, and how can I not get sick? And what is the underlying root cause?
Along the way, I discovered a couple of things. Just by self-experimentation, when I went to medical school, I took dairy out of the diet because I just didn’t have the time to sit and eat cereal with milk in the morning; I had to run out the door. Dairy became less of a presence in my diet, maybe I had the occasional ice cream. In college I had gotten sick so many times, so I was always really observant of any changes I made and how they affected my health. And what I noticed was that within a month of cutting out or not having as much dairy, and actually incorporating more healthy fats at the same time, (I was eating more olive oil and avocados), I stopped getting sick as often. I didn’t feel that fear I had about being around sick people. And it was the first fall where I only got a minor sniffle but didn’t get anything too major. I started making this association, even though I was in a traditional Western medical school where nutrition was given maybe one day out of the four years. I grew up in a household where my dad was very focused on nutrition and had done allergy testing, like food sensitivity testing. And this is, again, back in the 80s when it was not very common to see that. So that was infiltrated into my mind. Even though I was a child, I grew up around this. So I always thought that there must be something in nutrition, that there was some power to the way that we ate. So, I changed that in my diet. I stopped getting sick as often but I still had a lot of gut issues and I couldn’t figure out what it was. What was going on?
Little did I know that the antibiotics had led to leaky gut, had decimated my gut microbiome and led to sensitivities to the top big food groups that I was eating, which were gluten and dairy. Even though I had cut back milk and stuff like that, I was still eating occasional pizza and cheese, so dairy was still leaking into the diet. It wasn’t like a complete avoidance. But it really wasn’t until I had finished my medical training. And I was still suffering from IBS. You can imagine long hours at the hospital, sometimes they fed us pizza, getting a sandwich, not making the best food choices in the hospital where there really weren’t that many healthy food choices to begin with. And so, it wasn’t until after I completed my training that I started looking for other answers and other ways to look at things. And that’s when I discovered functional medicine. And when I learned about the microbiome and leaky gut, I started realizing that what I was dealing with was IBS or irritable bowel syndrome, which really was just an umbrella term for something that had many causes. For me, it was an imbalanced diet, eating too much gluten, still eating some dairy and having a decimated gut microbiome. So I started working on that.
I was in my 30s at the time and was so surprised that even within two weeks of cutting out gluten, I felt so different, my energy levels increased. By then, I was working, I had my own private practice and some days could be really long, it can be a 12 hour day, and I struggled in the afternoon. If I went and had a pizza for lunch, if I had a sandwich, I literally felt like I had been drugged. At 3 p.m., I was struggling to keep my eyes open while seeing patients. So I was looking for a solution that would just allow me to have more mental clarity, more energy, more focus. And within two weeks of taking gluten out, my energy shot up; the afternoon crash that I was having disappeared. And I thought wow, there is something to this. I was still early on in functional medicine, still somewhat of a skeptic, but looking at the science, trusting that the science was there. But at the same time, I was my own guinea pig. What I thought was going to be a life sentence of sensitive stomach, never knowing when I ate out if I was going to have to run to the bathroom if something was going to disagree with me, was really all about food choices and rebalancing the gut microbiome.
We cleaned out the diet and became a gluten-free household, limited dairy. I figured out which dairies I could have, like low-lactose cheese, but staying away from things that had a lot of lactose. Eventually, I figured out that I can seasonally eat dairy. So I’ll eat dairy in the summer, because I love cheese. But I avoid dairy fall, winter, spring. And this was after a couple of years of experimenting and realizing that even a little bit of cow dairy, specifically, in the fall, winter and spring, predisposed me to getting sick and more mucousy. When spring rolled around, I would get allergies. And when I took dairy out, all of that disappeared. And honestly, there were years when my patients were coming in with all sorts of allergy symptoms in the spring, and they’re always saying, “Oh, this is the worst allergy season ever”. And I honestly didn’t know that. The only way I could know more mechanically was on the worst days when there’s a high pollen count in the air. And inevitably, the pollen gets trapped in your eyelids and your eyes get a little bit irritated. That’s when I would feel it on those days. But otherwise, no more respiratory symptoms.
So, I became really fascinated with gut health and how it affects our overall health and started becoming very curious when patients came in with any sort of gut health issues and really paying attention not just to their gut health, but also curious about what other conditions or symptoms they were experiencing that went with gut health issues. They would come in with IBS and migraines, they would come in with IBS and allergies, IBS and asthma. I started making the association between the two and working with patients on their gut health issues, having at the same time been working on my own gut health issues and seeing that what I thought was not reversible after two decades or more of my life, actually was something that you could get under control with the right types of interventions.
Lindsey:
Yeah, awesome. That actually sounds a lot like my journey. I also discovered gluten and dairy were very detrimental to my health. So, you’ve already hit on a couple of the big ones, but what other things can disrupt the gut microbiome? That is, if you can’t easily track it back to something like heavy antibiotic use or food poisoning that led to SIBO or parasites.
Dr. Pedre:
Yeah, obviously, those are some of the big things that might be gut disruptors. But there are other things that maybe we don’t think of as things that cause food sensitivities, but sugar is a big gut disrupter because it can cause overgrowth of Candida. And for people who are mold sensitive, mold toxins can be big gut disruptors; living in a moldy home. And that’s the thing that I find so fascinating about the gut is that the symptoms might be the same between two people, or there might be a lot of similarities in how two people present. But the actual underlying reason why they’re having those symptoms can be very different.
Sometimes it’s a combination of things; it could be that they had been on antibiotics at one point, that they traveled to India, and they picked up a parasite, but they’re also mold sensitive, and they live in a moldy house, and that’s also affecting their gut and causing leaky gut and all sorts of problems. Or, maybe they are sensitive to lectins, and they’re eating legumes or they don’t know how to prepare legumes properly to reduce the lectin content and reduce the irritation of the gut lining. There’s a lot of other ones, including glyphosate pesticide, that can become a gut disruptor, because it’s basically a chelating agent that acts like an antimicrobial. So if you’re eating wheat that’s contaminated with glyphosate, that’s a double hit. So you’re getting the gluten, which increases gut permeability, and you’re also getting glyphosate, which is going to cause alterations in the gut microbiome.
There are things that people do every day, and they don’t think too much of it, because it’s part of our normal society. Some of the things are over the counter medications that you can take, and you think, well, if it’s over-the-counter, it means that it’s been FDA cleared, it’s fine, it’s not going to cause any sort of problems in the body. And yet, all of these come with warning labels, but none of them warn specifically about the fact that they can cause leaky gut. Ibuprofen increases gut permeability. Acetaminophen also can do it; not directly by affecting the gut lining, but by having an effect on the gut microbiome. And that then leads to increases in gut permeability, or what we call leaky gut. And lastly, people don’t think about this, but alcohol is a big gut disrupter. Probably, someone who’s listening might think back, sometimes we don’t notice things until you really put your nose on it and start paying attention. But maybe you might notice that you go out drinking, and maybe you have a couple of drinks the night before, and the next day, your gut isn’t feeling so great. Maybe you’ve got to run to the bathroom at some point. If you’re not connecting the two things, you might think that they’re unrelated.
But, we know now that alcohol also disrupts the gut microbiome. And anything that disrupts both the good and bad bacteria in the gut is going to result in having downstream effects on the gut lining, which increases gut permeability and leads to leaky gut, which then leads to all sorts of inflammation and increases inflammatory signals in the body. So there are a lot of gut disruptors that are part of our normal day to day existence. That’s why it takes so much education for people to understand how these things have these downstream effects that, starting with the gut, affect so many other aspects of our health.
Lindsey:
So specifically, what is alcohol doing to the gut? Is it killing bacteria?
Dr. Pedre:
It’s killing bacteria. Just think, what do we use to disinfect surfaces? We use alcohol. So when you’re drinking alcohol, and of course it depends on the type of alcohol, it’s going to wipe off some of your good bacteria. And that disrupts the gut. Now, depending on the drinks, maybe you’re having a sugary cocktail, maybe you’re having wine, maybe you’re having beer, there’s going to be carbohydrates. There are sugars related to that. There might be some yeast that is going to feed yeast overgrowth, so not only is the alcohol going to wipe down your good bacteria, but it’s also going to promote the growth of yeast in the gut. And for somebody who’s already sensitive because they had to go on a course of antibiotics that disrupted the gut, then adding these other gut disruptors is only adding more fuel to the fire.
Lindsey:
Obviously, alcohol is a big part of life for a lot of people. And I’m curious, how much drinking is too much? Because surely, there’s all sorts of things we do that upset our gut microbiome every now and then, like, even I eat a pizza every now and then because you’ve got to live too. So what do you think is a reasonable limit for someone who is used to social drinking?
Dr. Pedre:
That’s a debate, because what they found is that maybe we can work backwards, that one drink a day, for women specifically, increases the risk of breast cancer. And that’s only a couple of milligrams of alcohol. So there’s got to be some sort of happy medium there. But knowing that every time you’re having a drink, you’re causing some level of gut disruption. If you’re having one drink daily, you’re also increasing your risk for cancer. But if you have less than that, maybe you’re having two to three drinks per week socially, then that’s having less of a weighted effect, right? Because the more you have, the more of an effect it’s going to have. Now, the thing is that alcohol is also going to increase inflammation in the body, because alcohol increases the release of inflammatory markers like IL-6 and IL-10. So it’s having an effect at some level.
I think that’s why when I’ve had people do an elimination diet, one of the things that we take out along with wheat, dairy, and some of the other disruptors like corn, soy, legumes and nightshades is alcohol. Because, again, it’s a gut disrupter, and sometimes you don’t really notice what something is doing to you until you take it out. And then you reintroduce it. So, I think that it’s important to make these wise decisions and understand what your body matrix is, how you’re feeling in general, and if you already have ongoing chronic inflammation, if you have mental health issues, if you’ve got some brain inflammation, then alcohol is only going to make that worse.
The interesting thing is, now looking at it through the lens of the gut, understanding that alcohol has some toxicity to the brain neurons, but it also is toxic to the gut microbiome. By doing that, it’s altering the good microbes in a way that will increase gut permeability. And whenever you increase gut permeability, you’re going to increase the influx of inflammatory substances, whether it be bacterial DNA, (bacteria actually has been found to get into the circulation), or products from the bacterial cell wall like endotoxin, that then stimulates your white blood cells and causes the release of more inflammatory mediators, eventually leading to things like insulin resistance that scrambles your insulin signal. So you start producing more insulin, which tells your body to convert carb calories into fat. You start gaining weight in the middle, and then that fat in your belly starts to produce its own inflammatory signals, and then it becomes a cascade. So you have to understand where you’re at, because we’ve thought of alcohol as liquid calories, and why some people have difficulty losing weight if they do a pretty strict diet, but they’re still drinking one to two drinks per day. And it’s probably not just the calorie effect from the alcohol, it’s also the inflammation-inducing effect of the alcohol, that’s not allowing the body to shed the fat.
So, I’m not going to say that everyone should give up drinking alcohol, but I am going to say, depending on your own underlying issues, it’s definitely something to consider or to really pull back on, especially if you have certain health goals that are not compatible with drinking alcohol, in those situations, because of the disruption that it’s going to do to your gut. Namely, the increase in inflammation and the problems with brain health. I know we’re talking about gut health but given the rising rates of dementia and Alzheimer’s in the country, alcohol is the enemy of brain health.
Lindsey:
Okay. So you mentioned endotoxemia in that last bit. Can you talk a little bit more about that and about dieting as it relates to endotoxemia?
Dr. Pedre:
Yeah. So endotoxin is a lipopolysaccharide. It’s a lipid/sugar short chain carbohydrate molecule that is made as part of the outside of the cell wall of gram-negative bacteria like E. coli. Everybody’s probably heard of E. coli that lives in the large intestine. And the interesting thing is, when it was discovered, they called it endotoxin, because they thought it was retained, and the only time it was released was when the bacteria died, and it was shed. But it turns out that these bacteria actually release endotoxin, and that endotoxin can be absorbed into the circulation. Obviously, the more endotoxin is going to get through, the more leaky the gut is, and the more permeable the gut barrier is. Now, endotoxin has the ability, because it is a part lipid molecule, to get through cell membranes. And one of the areas that it can get through is the blood brain barrier, which is a protected circulation that keeps the brain circulation separate from the rest of the body. But anything that’s fat soluble is going to be able to get through there, and lipopolysaccharide, another name for endotoxin, can get through.
What endotoxin does, and in a variety of tissues in the body, not just the brain, but also the liver, muscles and pancreas, is it increases the expression of an inflammatory genetic pathway inside the cells. When this pathway is activated, the cell is producing more inflammatory chemicals and releasing inflammatory signals to its environment. So it does this in the hypothalamus in the brain, in the liver and muscle tissue. And part of the effect that this has is increasing insulin resistance, insulin being the hormone that tells your body to push the sugar from your circulation into the cells where the sugar is going to be used for energy production, and sugar is coming from the breakdown of carbohydrates in the diet. And we know that insulin is probably one of the most powerful aging molecules in the body. So, you don’t want too much insulin. Insulin will raise blood pressure, and it increases the likelihood of more calcifications and plaque formation inside the arteries. So the higher your insulin, the more accelerated heart disease you’re having. And it also is a signal that tells your body that it needs to conserve energy as fat. So your body will take the calories when insulin is high, and start packing them in your belly as fat, and you start to accumulate visceral fat, which then becomes a feed forward cycle. So the visceral fat also will increase insulin resistance and more insulin resistance causes more fat in the belly.
So now you can visualize this process, that there’s a trigger that’s coming from environmental aspects, whether it’s over the counter meds, antibiotics, poor diet, too much sugar, over processed foods, leading to an increase in gut permeability, or leaky gut. And as a result, there’s more endotoxemia coming in, more endotoxin that gets into the circulation, which activates white blood cells, signals inflammatory cascade in a bunch of tissues in the body and starts to cause a weight gain in the person. Now we also know that there is endotoxemia that tends to follow eating. And it seems to happen more with inflammatory oils. So nuts and seed oils are going to have more endotoxemia. The one that has the least amount of associated endotoxemia is olive oil.
However, there is a certain element of endotoxemia that happens after a person eats, and it’s interesting, because there’s a doctor that specializes in cardiovascular health, Dr. Mark Houston, and I heard him present on endotoxemia and do an experiment where they gave somebody a meal–I think it was like a burger or something like that–a pretty inflammatory meal, and they measured endotoxin levels post meal. You can also measure things like anti-endotoxin antibodies, which is one indirect way to see how likely does a person have leaky gut. But what they did is they replicated the meal. So they did one without and one with broccoli. And when they gave people broccoli, it actually reduced the endotoxin load. That was really fascinating. So this was a plant-based diet being protective against endotoxemia while an inflammatory diet with lots of starches, sugars, heavy on meats can cause more endotoxemia, especially with saturated fats, which are going to pull that endotoxin through the gut barrier into the circulation, and even worse if you have leaky gut.
Lindsey:
So you mentioned an animal-heavy diet causing endotoxemia. You also mentioned lectins and preparing legumes properly. And, of course, if you are not eating a lot of meat, then you need to be getting some of your protein probably from beans, lentils and such. So tell me about how people can eat those things safely.
Dr. Pedre:
The important thing to know is that traditionally these foods are obviously not eaten raw, initially. One thing that we’ve done in Western society is we’ve shortened the time interval, so we’ll take a raw bean and then we’ll just cook it outright and not have soaked it. There are several things that can help reduce the the gut-irritating effects of lectins on the gut from beans and legumes. The main thing is soaking them overnight, and then rinsing them out and using fresh water to cook them the next day. Another thing that is really helpful is to cook them in a pressure cooker. That’s also going to help reduce the lectin content by another 30% to 50%, just by cooking them in a pressure cooker. You can also add a little bit of sodium bicarb to reduce the gas-producing effects from the sugars in the beans. Or you can add kombu*, which is a seaweed that you don’t necessarily eat but you use it during the cooking process, and it also helps to make the beans more digestible. Now, there are certain beans that are a bit easier on the digestion like mung beans* and adzuki beans*. They’re good for people who have trouble digesting regular beans. The other thing that you can do with beans if you have the patience, or you can also in some health food stores find them this way, is sprout them. So you can get sprouted beans that have been soaked and sprouted. Now their nutrients have been activated, and they also have been made much more digestible. So you can get easier access to the nutrients in the beans, like the protein, the minerals and all the other great nutrients inside. It also makes it easier on the digestion for people who are really plant focused.
Lindsey:
Obviously, we know that gluten is inflammatory and has issues, but do you think everyone should avoid gluten or just the people who are sensitive to it?
Dr. Pedre:
It’s a really great question. And there was a study that was done a couple of years ago that actually looked at the effects of gluten on three groups of people. One group was people who had a diagnosis of celiac disease. That’s an autoimmune intolerance to gluten, and that’s about one to 2% of the population. The next group was what we call NCGS–non-celiac, gluten sensitive. And this represents anywhere between 2 and 10% of the population. Probably, I would suspect, it’s much on the larger end. And then the third group were people who are considered normal. They didn’t have any signs of gluten sensitivity. They didn’t have celiac disease or celiac genetics. So they looked at the effects of gluten on their gut permeability, and as expected, people with celiac disease when exposed to gluten had the greatest increase in gut permeability. When people with non-celiac gluten sensitivity, who we know are still sensitive, though they’re not as extreme as celiac, they also had an increase in gut permeability, but not as great as people with celiac disease. The mechanism is that when you have gluten It breaks down into its protein molecules and gets absorbed by the cells that line the intestines, gluten actually triggers the release of zonulin, which is like the dimmer switch that controls gut permeability by increasing or decreasing it, depending on how much zonulin is getting expressed in those cells that line the intestine.
So you would think that someone who is normal would have zero increase in gut permeability from being exposed to gluten. But that’s not what they found. What they found is that even people who were “normal” actually had a small, but still measurable increase in gut permeability. So, depending on genetics and predisposition, one thing that can happen for people is that this could be a lifetime hypothesis. Maybe you’re fine when you’re young, and then a lifetime of exposure to gluten augmented by maybe having had to go on antibiotics for an infected tooth, and then you get a UTI or pneumonia, and you have to go on antibiotics again, and then you’re still eating gluten. So you’ve had other things that increased gut permeability. Or, maybe you hurt your knee and you were taking ibuprofen. So now you’re adding factors that are increasing gut permeability, and they’re allowing more of that gluten to get through.
Eventually, if you have a genetic predisposition, it’s very possible that you would develop some sort of condition, like an autoimmune disease, for example, that could be triggered by the environmental trigger of gluten. This was the research that Alessio Fasano did, where he was looking at what is the pathway to autoimmune disease, and he hypothesized that autoimmune disease starts in the gut, and it involves three important things. One is a genetic predisposition. The second is an environmental trigger. So the environmental trigger that he was looking at was gluten, because from his research and findings, the surface of the gluten molecule can be confused by the body as if it were a foreign bacteria. So it’s perceived as an invader, especially if it’s not broken down properly, so it’s a more intact protein. Then it’s going to be very antigenic, and it’s going to provoke an immune attack. And then the third factor that he found was necessary in this pathogenesis of autoimmunity was leaky gut. So if you have a genetic predisposition, you have an environmental trigger and then you have leaky gut, it’s very possible that you could develop an autoimmune disease somewhere down the road.
Interestingly, when I went to medical school, we initially learned that celiac disease was a diagnosis in pediatrics, and it would be something that you would pick up early in life. We never really thought that celiac disease could start later in life. And yet, I had a patient who came to see me–she was 52 years old. And she was having a lot of gut issues, but she also tested positive for autoimmune markers for thyroiditis (for autoimmune thyroid), and she just didn’t feel well. We decided, because of her history and her background, to do celiac genetic testing, and we found out she was positive for celiac genetics. Not only was she positive, but when I sent her for an endoscopy, she had positive findings on endoscopy for celiac disease. And she was 52 years old at the time. So you wonder, did she have celiac disease all along? Was it something that she maybe developed younger, but didn’t know? I don’t think so, because when I’ve seen younger individuals with celiac disease, it hits them pretty hard, and they suffer a lot when they eat gluten. So, we could hypothesize based on the fact that we know that gluten can increase gut permeability, even for people who are normal who don’t have any autoimmune disease, that a lifetime of exposure eventually could reach that threshold level, where it’s the straw that breaks the camel’s back that finally triggers the Pandora’s box of autoimmunity to get this condition. And again, this is a byproduct of multiple factors; namely, genetics, environmental trigger, and leaky gut.
Lindsey:
Yeah, I think that is a path I see people on frequently with Hashimoto’s Disease like I have, but fortunately I got my antibodies down to zero.
Dr. Pedre:
That’s great, and that was my motivation. When I decided to take gluten out of my diet, which was in 2007, (obviously, a lot of it was related to looking to fix my gut issues), but my mom had been diagnosed with rheumatoid arthritis, and my older sister has multiple sclerosis. So I was learning about the connection between gluten, leaky gut and autoimmunity. Part of my motivation was to fix my gut, but also, part of my motivation was to prevent the development of any autoimmune disease later in my life. I was about 34 years old at the time and I thought I can do without gluten if it means investing in my future and investing in my future health.
Lindsey:
Yeah. So are canned beans already soaked? Or no?
Dr. Pedre:
No, very unlikely. Canned beans are more often than not going to be quite irritating to the gut lining, and depending on the can, also, I think a lot of them have been replaced and are now BPA-free. BPA is quite an irritant for the body and actually activates the immune response and has been found to be a trigger for autoimmunity in and of itself. A lot of these cans are lined with BPA now you have “BPA-free” cans, but even other forms of PA, like non Bisphenal A, could potentially be toxic. So again, like anything, the best is to make food the most natural way possible and the more homemade that you can. Yes, it is an extra step. Yes, you have to buy the dried beans or the sprouted beans.
Lindsey:
And you have to remember to start soaking them the night before.
Dr. Pedre:
Yes, and you have to soak them and then remember to rinse them out. But it doesn’t take that long to put beans in a pot and soak them overnight.
Lindsey:
And same thing for lentils? Or are those okay?
Dr. Pedre:
The same thing you should do with lentils, although with lentils, you can usually get away with soaking them less than overnight, you can soak them for a couple of hours and they’ll be fine. And dal, actually, is another thing that’s easier on the digestion. So mung beans, adzuki beans and dal are ones to think about if you want to incorporate beans, but you want to test them out and you know that you don’t react well to regular beans. But know that if you eat out and beans don’t agree with you, those beans were probably not soaked and rinsed and cooked in a pressure cooker before. And they probably didn’t have added bicarb or kombu seaweed to reduce the gas promoting effects of the beans.
Lindsey:
So do you think that a diet without dairy requires some amount of calcium supplementation? Like what’s the evidence for that?
Dr. Pedre:
Yeah, that’s the thing that I think led me down the wrong path growing up, because so many commercials would say “dairy does the body good” and “dairy makes your bones strong”, and if you don’t have dairy, you’re not going to have strong bones. The truth is that dairy actually causes leaching of calcium out of the bones. I don’t know if you’ve ever read the China study or looked at the research behind it, where they looked at the diets across the world, and they found that the highest bone densities and the lowest risk for osteoporosis, even postmenopausal, were in regions of the world where they actually ate very little dairy, and the highest incidence of osteoporosis is in the western world where dairy consumption is quite high. So it has to do with the the alkaline and acid balance. It’s really about eating a plant-rich diet, which is going to be very alkalizing, and it’s going to allow your bones to retain that calcium, especially for women as they go through menopause. But men also are not free of risk. They might not be as high risk at 50 years old as women when they’re going through menopause, because in those first two years is when a significant portion of the bone masses can potentially be lost. But men need to think about osteoporosis leading into the 70s.
Lindsey:
So what is the best diet overall for having a diverse microbiome?
Dr. Pedre:
That’s a great question. There was a study that Stanford University did in 2021. They looked at a high fiber diet versus a high fermented foods diet in a group of women over a 10-week period. They had done microbiome testing at the beginning and then at the end, without altering any other behaviors. When we think about a high fiber diet and functional medicine, we talk about eating the rainbow, like eating a variety of plant-based foods that are rich in all sorts of soluble and insoluble fibers. And we think of that as what feeds the microbiome and will create diversity, right? Because fiber is basically our indigestible carbohydrates. We also call them resistant starch that feed our microbiome and produce a whole bunch of really important post-biotic products like short-chain fatty acids.
When I heard about this study, and I was reading it, I was thinking for sure, the high fiber group has to be the one that’s going to gain the most microbial diversity. But it wasn’t. It was the high fermented foods group, and they were eating about two to four servings of fermented foods like sauerkraut, pickles and yogurts every day. Not only did it increase microbial diversity in their gut in this 10-week study, but it also lowered 19 inflammatory markers. Now if you’re you’re listening to this, you may be wondering in your head, are you telling me, Dr. Pedre, that I should now start eating fermented foods and not eat so much fiber? Well, it’s not quite clear. And that’s why in my book, The GutSMART Protocol*, I designed a quiz that separates people into mild, moderate or severe categories, because what I found is that if you have severe gut issues, you’re not going to be able to tolerate fermented foods. There’s no one size fits all. But within that, it’s important to know that ultimately, as you heal your gut, the goal is to start incorporating fermented foods.
Now, I want to say something about the high fiber, because we need to consider that fiber is protective of colon cancer, it’s important to keep your poop moving through. So you want to make sure you’re having daily bowel movements. Fiber is a very key part of that. But what they did find in the study, and it seemed to have a better effect, depending on the baseline microbial diversity of the person, the high fiber diet helped create some level of immune modulation that controlled the immune system, keeping it from being over-reactive. And even though the high fiber group didn’t experience a drop in the 19 inflammatory blood markers that they were looking at, they did see that there was some level of immunomodulation. So from this one study, it’s a small study, it was only women, and it was a short study, I think we need to expand the study and look across ethnic groups, men and women to see if this is something that’s reproducible.
I think the takeaway here is that the best diet for gut health incorporates more fermented foods than probably most people are used to having. And once you heal your gut, if you take the GutSMART quiz in my book*, and you come out at severe, you can’t eat fermented foods. Once you get to moderate, you can only dip your toes in them. It’s not the American way, where if a little is good, a lot is even better, you’ve got to be really careful about when you’re incorporating fermented foods to start with small doses, even like a quarter teaspoon and slowly work your way up.
But the best diet, based on this study’s findings and other studies that we’re starting to hear about, in terms of the effects of combining of fiber and fermented foods, is that it also has a very positive effect on mental health, anxiety and depression. So, I think the answer is in between. We can’t say that fiber is the solution for everything. But I think in a society where we don’t eat enough fiber to begin within the United States, the average person needs 10 to 14 grams per day–the goal is anywhere between 25 and 35 grams a day. There are more primitive societies like the Hadza hunter-gatherers of Tanzania that eat up to 50 grams of fiber per day. So we’re getting a fraction of what our ancestors ate in fiber because of all the processed foods, so in general, everyone could use a bit more fiber in their diet. But along with the fiber, they need some fermented foods. And to find out if you’re able to eat fermented foods, they can check out the GutSMART quiz in my upcoming book, the GutSMART Protocol*.
Lindsey:
Okay. So I’m wondering, because I have post-infectious IBS, and periodically I’ll have rounds of SIBO, if probiotic foods are contraindicated for someone like me, or say people with histamine intolerance?
Dr. Pedre:
Yeah, those are other very important contraindications. Someone who has histamine intolerance or someone who has SIBO is going to have a very difficult time tolerating probiotic supplements in general and may even have a lot of trouble with fermented foods. Now, they might be able to have a very tiny amount of kraut juice where they can have a quarter teaspoon at a time, and that might be okay. But they do have to be really careful. Obviously, SIBO is an imbalance in the gut, an overgrowth of bacteria in the small intestine that needs to be corrected and might have a number of underlying issues. It could be hydrogen, methane, or it could be hydrogen sulfide gas, depending on the underlying reason the solutions are slightly different. Someone who has histamine intolerance or mast cell activation disease is ultimately going to have a gut microbiome imbalance and leaky gut, and part of the reason that they have histamine intolerance is because their gut barrier has been compromised. So the focus would be on healing the gut.
There’s good research showing that spore-based probiotics like Bacillus coagulans and Bacillus subtilis might actually be okay in small doses and slowly increasing for these patients, because they help reestablish the gut terrain. They help promote the growth of the right bacteria, but they also inhibit the growth of the wrong bacteria in the wrong location. Because when you have SIBO, it might not be that there’s bad bacteria; it might just be bacteria in the wrong place in your gut. There’s some evidence that the spore-based probiotics can help improve gut permeability as well, or reverse leaky gut.
Lindsey:
So if you got into your gut issues because of an extremely stressful period in your life, I’m wondering whether you think dealing with your stress and decreasing your stress could restore your gut microbiome, or in your experience, does it take more than that?
Dr. Pedre:
Well, I always like to say that you can’t out diet or out supplement a stressed out lifestyle. I’ve certainly had those patients over the years that were checking off all the right boxes. They were following the right diet, they were taking all the right supplements, but they live their life in a straitjacket of stress, running from meeting to meeting. They just wanted the solution to be mechanical, but not address all of the other underlying issues, which are really important because stress is like an attack on the gut and stress also will increase gut permeability. And that’s the reason that I included a section in my book that has a very strong focus on diet and how to heal the gut through diet. I have a section called turbocharging your results, for the very reason that the mind-body connection is very important, not just the gut to the brain, but the brain to the gut through the vagus nerve. Incorporating things like mindfulness meditation and breath work are also key components of the healing process, because when you do these activities, when you do specific breath work and meditation, it helps activate the vagus nerve. When your ventral vagus is activated, it tells your body that it’s safe, and when your body feels safe, your body can heal itself. So it’s very important. Not only that, but when your body is in an activated ventral vagal tone, it’s in a parasympathetic state, which means your body is relaxed, and it can digest and absorb nutrients more easily.
Lindsey:
Okay, well, we’ve covered a lot of different topics in here. Thank you so much for sharing your knowledge with us. I really appreciate your time.
If you’re struggling with bloating, constipation, diarrhea, soft stool, acid reflux, IBS, IBD or any type of chronic disease, etc. and want to get to the bottom of it, that’s what I help my clients with. You’re welcome to set up a free, 30-minute breakthrough session with me (Lindsey). We’ll talk about what you’ve been going through and I’ll tell you about my 3- and 5- appointment health coaching programs in which I recommend lab tests, educate you on what the results mean and the protocols used by doctors to fix the problems revealed. Or if you’re ready to jump in right away or can just afford one appointment at a time, you can set up an 1-hour consultation with me.
