The Science of Gut Health | Dr. Robynne Chutkan

Why it matters for mental health; how to make improvements without succumbing to snake oil; and why you should be looking at your poop. Dr. Robynne Chutkan https://gutbliss.com/ is a board certified gastroenterologist and the author of the four books https://gutbliss.com/books/Gutbliss, The Microbiome Solution, The Bloat Cure, and The Anti-Viral Gut. She's also the host of The Gutbliss Podcast https://gutbliss.com/podcast/. Paid subscribers of DanHarris.com will have exclusive access to a set of all-new guided meditations, led by friend of the show Cara Lai https://www.caralai.org/#/, customized to accompany each episode of the Get Fit Sanely series. We're super excited to offer a way to help you put the ideas from the episodes into practice. Learn all about it here. https://www.danharris.com/p/a-month-of-guided-meditationsjust In this episode we talk about: The relationship between gut health and mental health The microbiome, why it's important, and how you can view the microbiome through a Buddhist lens A crash course on the digestive system How to navigate the snake oil – and why some supplements you are taking could be making your gut worse We go deep on acid reflux The downsides of chewing gum Distinguishing belly fat vs bloat Why not all gas is bad Related Episodes: Your Brain on Food | Dr. Uma Naidoo https://www.danharris.com/p/your-brain-on-food-dr-uma-naidoo-705?utm_source=publication-search The Science Of How Nature Changes Your Brain—From Sleep To Cognition To Your Nervous System | Dacher Keltner https://www.danharris.com/p/the-science-of-how-nature-changes-c75?utm_source=publication-search How To Get The Physiological And Psychological Benefits Of Nature If You Don't Live Near Nature | Dacher Keltner https://www.danharris.com/p/how-to-get-the-physiological-and-0f4?utm_source=publication-search The Science Of Walking: The Benefits Of Walking In Nature, Walking Meetings, And Walking Meditation | Dacher Keltner https://www.danharris.com/p/the-science-of-walking-the-benefits-d0d?utm_source=publication-search I Just Went Through A Career Earthquake. Here's What I Learned About Anger, Insomnia, And Bouncing Back | Dan Harris https://www.danharris.com/p/i-just-went-through-a-career-earthquake-191?utm_source=publication-search Behind The Scenes Of The 10% Happier Podcast + A Sneak Preview Of Something Big http://danharris.com/p/behind-the-scenes-of-the-10-happier-3a3?utm_source=publication-search How To Be Sanely Ambitious | Behind the Scenes with Dan and DJ https://www.danharris.com/p/how-to-be-sanely-ambitious?utm_source=publication-search Join Dan's online community here http://www.danharris.com Follow Dan on social: Instagram https://bit.ly/3tGigG5, TikTok https://bit.ly/3FOA84J Subscribe to our YouTube Channel https://bit.ly/3FybRzD To advertise on the show, contact [email protected] or visit https://advertising.libsyn.com/10HappierwithDanHarris

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:04Dan Harris?

  This is the 10% Happier Podcast. I'm Dan Harris. Hey, everybody. How we doing? As you probably know, your gut health is incredibly important for your overall health and specifically for your mental health. You may have heard about the gut-brain axis, a two-way communication system involving nerves, hormones, and immune signals. The gut microbiome helps regulate neurotransmitters like serotonin and can influence inflammation, which affects mood and cognition.

• 0:46Dan Harris?

  In short, a healthy gut can help support clearer thinking, better stress resilience, and a more stable mood. And yet, when it comes to addressing your gut health, there is so much bullshit and snake oil out there, like a tidal wave of nonsense. So today, we've got one of the world's leading experts on gut health. She's not trying to sell any supplements to you. She's just trying to give you some basic tools to have a healthier gut so you can have a healthier brain. And she's not afraid, as you will hear, to take this conversation into some supremely uncomfortable areas, including the importance of looking at your poop. Dr. Robin Chutkan is a board-certified gastroenterologist and the author of four books, Gut Bliss,

• 1:31Dan Harris?

  The Microbiome Solution, The Bloat Cure, and The Antiviral Gut. She's also the host of the Gut Bliss Podcast. In this conversation, we talk about the relationship between gut health and mental health, the microbiome, what it is, why it's so important, and how you can view it through a Buddhist lens. She gives us a crash course on the digestive system 101. She talks about how to navigate all the snake oil out there and why some supplements you're taking might be making your gut worse. We go deep on acid reflux, a bugaboo of mine. We talk about the downsides of chewing gum, how to distinguish belly fat versus bloat, and why not all gas is bad. Just to say before we dive in here, we're now in week three of our month-long

• 2:13Dan Harris?

  series called Get Fit Sanely, where we talk about how to take care of your body without losing your mind. Every episode this month comes with a bespoke guided meditation only for paying subscribers over on danharris.com. Today's meditation is called When You Want to Eat Your Feelings. In it, the great Dharma teacher and my friend, Cara Lai, helps you eat mindfully, which is a game-changing skill in my experience. For more information, head on over to danharris.com. Okay, we'll get started with Dr. Robin Chutkan right after this.

• 2:45Speaker 01

  How do I recover from a friendship breakup? How come there's nowhere to hang out anymore? Why do I feel lonely when I can communicate with anyone and everyone through my phone? These are the questions that you're not alone in asking, and that's where our new podcast, Cornerpiece, comes in, to start small on life's biggest questions. I'm Taha, and with my friends Sabrina and Melissa, we're going to explore life's ungooglable questions on this new podcast with TED. Come hang out with us on Cornerpiece, with new episodes every other Thursday, wherever you get your podcasts.

• 3:19Dan Harris?

  Dr. Robin Chutkan, welcome to the show.

• 3:21Speaker 02

  Thank you so much, Dan Harris, for having me.

• 3:26Dan Harris?

  I feel like this conversation is going to make me uncomfortable all sorts of ways, which I'm looking forward to. That's always the sign of a good conversation.

• 3:32Speaker 02

  As long as you're prepared to discuss your bowel movements in detail, there's absolutely nothing to be nervous or worried about.

• 3:40Dan Harris?

  Here we go. All right, so let me start at the high, high level. You look at gut health. I want to understand why is that so important, especially as it pertains to mental health?

• 3:53Speaker 02

  So the first thing I want you to do, Dan, is just look down at your belly, like literally just look down and see where your gut is located.

• 4:01Dan Harris?

  I'm looking.

• 4:02Speaker 02

  It is in the absolute center of your body.

• 4:04Dan Harris?

  Yep.

• 4:05Speaker 02

  It is literally the engine for everything. So imagine like a wheel and then there are spokes going off. So there's a spoke going up to the brain, stuff to the heart, the lungs, the bones, the joints, the immune system. So your gut is the engine that drives everything. Full disclosure, I don't know anything about car engines, but I would imagine that if your car engine breaks down, even if the brakes are working or the carburetor is working or something else, you are not going to get very far because your engine is not working. So the gut really fuels the entire body. And here's the interesting thing, even if you're eating a super healthy diet, if any of the major components of the gut are off, if the gut lining is too permeable, if the gut pH is off, if the gut microbiome is disrupted,

• 4:50Speaker 02

  you are not going to be absorbing those nutrients properly. So you can be eating a super healthy diet. If the gut is not optimized, those nutrients aren't going to get absorbed and assimilated, and they're not going to get to the brain and the immune system and all the other parts of the body. So that's why the gut, you know, everybody in medicine thinks that their field is the most important. The neurosurgeons think it's the brain, ah, but it's the gut. I'm here to tell you.

• 5:15Speaker 02

  For sure.

• 5:16Dan Harris?

  Let me just go back to one aspect of the question. I think I understand writ large why the gut is so important as the hub of the body. But this is a show that concerns itself with the mind. Everybody knows there's a gut-brain connection. Can you just hold forth on that idea?

• 5:33Speaker 02

  Sure. So you mean, we're not going to spend the entire hour talking about bowel movements? And how to have, you know, mama jam a poos and stool Nirvana? Or this is mental health? Absolutely, absolutely. In all seriousness.

• 5:43Dan Harris?

  We will get to all those things. We will get to all those things, I promise. I'm going to push it off as long as possible.

• 5:48Speaker 02

  There is something called the enteric nervous system, which has been referred to as a second brain in the gut. And it has about seven times as many nerve cells as a spinal cord. It doesn't have as much as a central nervous system, but it is very highly innervated with nerve cells. And there is this constant sort of bidirectional communication. The gut is communicating with the brain and the brain is communicating with the gut. And what are they telling each other? The brain is controlling things like gut motility, enzyme secretion, and also nutrient absorption that we talked about. And the gut is controlling things like mood and memory. And when I say controlling, not completely, but influencing dramatically. And a lot of that influence has to do with

• 6:28Speaker 02

  the neurotransmitters that work in the brain, things like serotonin and dopamine, et cetera. But they're actually co-produced in the gut. Gut bacteria are really essential and not just a bacteria. You have to have the optimal pH, you have to have the optimal sort of enzymatic milieu for those neurotransmitters and other substances to be adequately produced and transmitted to the brain. So it's really a very, very clear connection. I mean, the gut-brain connection is probably more important, if you will, than the gut connection to any other organ.

• 7:02Dan Harris?

  Anytime any part of your body is in pain or discomfort, it will impact your mental health. But there's something really key about if your stomach is rumbling, either from hunger and then you get too hangry, or from an upset stomach where you get too irritable. I'm thinking of the word dyspeptic, which I believe is connected to the gut, as in Pepto Bismol.

• 7:33Speaker 02

  Absolutely. Yeah.

• 7:34Dan Harris?

  Yeah. And in the reverse direction, that when you have something psychological happening, it can impact what's happening in your gut. This seems, of all the body parts, to have an outsized influence on our well-being on a moment-to-moment basis.

• 7:50Speaker 02

  A hundred percent. And the term you just described, dyspeptic, so dys meaning off, and peptic is really stomach, referring to Pepsin and other digestive enzymes. So it's sort of an off-stomach. If we look back at the 1800s to conditions like melancholy, which we now consider to be a form of depression, we know that people were treating melancholia with diet, changing their diet, putting them on a high-fiber diet, we'll talk about that, from as far back as the 1880s. We know that Parkinson's disease, a disorder that we think of as affecting the brain, we think of Parkinson's, it's a movement disorder, it involves the brain, and it's a degenerative brain disorder. We know that it begins in the gut. There's

• 8:32Speaker 02

  a theory called the gut-first theory of Parkinson's, and it was shown by a German neuroanatomist, Dr. Brock, that the changes that you see in the brain, years before, sometimes decades before the patient manifests signs of Parkinson's, there are these changes in the gut, in the neural cells along the lining of the gut. And they've done some really sophisticated experiments where they have taken some of these proteins and injected them into the gut in mice, and then showing the Parkinsonian changes turning up in the brain and the behavior in the brain later on. So we think of these diseases as brain diseases. We think of diseases like Parkinson's and autism spectrum and some forms of dementia like Alzheimer's. And they very much are brain diseases, but it turns out that a lot

• 9:16Speaker 02

  of them actually have their origins in the gut. So we have evidence, for example, with Parkinson's of something called the gut-first theory. Dr. Brock looked at the brains of Parkinson's and he could see these abnormal proteins called alpha-synuclein proteins. But then he also saw them in the gut, and he saw them in the gut, Dan, sometimes decades before the changes were turning up in the brain. Now, of course, these are autopsy studies, but they've done some really sophisticated studies in mice where they inject the abnormal protein from the brain into the gut and they see it traveling up and they see Parkinson developing. So this is from the basis of, again, something called the gut-first theory that suggests that a lot of these disorders actually have their origins in the gut. And

• 10:00Speaker 02

  I think that's one of the clearest connections between the gut and the brain.

• 10:04Dan Harris?

  We will go deep, deep, deep on practical aspects, but let me just stay at a high level for a second in terms of getting you to teach us about the gut. What is the microbiome? And why is that important?

• 10:19Speaker 02

  The microbiome refers to all the organisms that live in and on our bodies, mostly in our gut, and not just bacteria. Certainly bacteria constitute a large proportion of the microbiome, but also viruses, fungal organisms, parasites, one cell protozoa organisms, and archaea. So there are several different types. If we sort of scraped them all up, they are of course microscopic, but if we scraped them all up, they'd weigh about three or four pounds. And they're a more unique identifier of you than your own DNA. So I can recognize Dan Harris with more accuracy by looking at your microbiome than I can by looking at your DNA.

• 10:58Dan Harris?

  So there are ways to eat and exercise that all impact the microbiome?

• 11:06Speaker 02

  Absolutely. Everything we do impacts our microbiome. Our microbiome reflects where we've lived, what we've eaten, medications we've taken, the stress in our life, whether we've had a dog in our family or not. All of these things impact what's going on in the microbiome. And yes, diet is probably the most potent tool for modifying sort of where we are now, right? We have the microbiome. We have, based on whether we were born vaginally or via a C-section, whether we were born at home or in a hospital, whether we were nursed, what we've eaten, the medications, the stress, all of these things. But where you are now, and particularly if you are somebody struggling with mental health, struggling with an autoimmune disease, or just bloated and constipated and looking to have better

• 11:49Speaker 02

  gut health, the food, the diet, is an incredibly potent tool because what these microbes eat really influences what they're making, the postmetabolites that they're creating, things like short chain fatty acids that have a profound impact on our brain health and our gut health and our immune health.

• 12:09Dan Harris?

  Whenever the microbiome comes up in conversation, which is actually not super rare in my house, given that my wife spent some time researching the microbiome as it relates to transplant patients, back when she was a researcher, I always think about it through a Buddhist lens. You know, in Buddhism, one of the primary assertions is that the self is not as real as we think it is. Yes, I am Dan, but on some fundamental level, there's no Essence of Dan, it's just made up of lots of composite parts. And many people think, well, my body, they pound their chest and say, well, this is me. But three pounds of you are other living organisms. And so that's just such a fascinating thing.

• 12:51Speaker 02

  And not just three pounds of you, because that might seem sort of inconsequential as a small percentage of your weight, but we have three to four times as many microbial cells as we have human cells. So we really are more microbes than humans. I love the Buddhist analogy, and I also like to think of it as a beehive. So the hive is an inanimate object and the hive is animated by the bees. That's who's doing all the work. So the microbes are synthesizing, the neurotransmitters are clearing out toxins, are helping with absorption, they're training the immune system. They are co-producing things like vitamin K that we can't produce on our own without our microbes. So we are really animated by them.

• 13:32Dan Harris?

  Fascinating. The next question I want to ask, so we can get a clear sense of the landscape here is, can you give us a 101 on the digestive system?

• 13:43Speaker 02

  Sure, I would love to. The digestive system really encompasses from our mouth to our anus. And actually, a funny story about that. When I was writing my first book, Gut Bliss, which came out now about 12 years ago, my daughter, who at the time must have been about six or seven, she said, Mommy, you should call it In the Gut and Out the Butt. And that sort of sums it up, right? From mouth to anus. So even though the air, nose and throat folks claim the mouth, the mouth is where digestion begins. And digestion begins, Dan, before you even eat. When you see the food, if you smell the food, even thinking about certain foods can create a salivary response, right? So our salivary glands start to release enzymes, amylase.

• 14:27Speaker 02

  Different sort of enzymes that help to break down the food. So digestion really begins in the mouth. The salivary enzymes start to work on breaking down the food. And then from the mouth, it travels down this sort of straight, long tube called the esophagus. And it travels sort of like that inchworm. It contracts, releases, contracts, releases to help it get down. At the top of the esophagus, you have the upper esophageal sphincter that has to open to let the food into the esophagus. Then you have a lower esophageal sphincter at the bottom. And when that one opens, it lets the food into the stomach. And then in the stomach, the food is churned up into something called chyme, into these small pieces. And that's also where a lot of the enzymes, things like gastrin and different peptic enzymes start to break down the food.

• 15:11Speaker 02

  Hydrochloric acid is released by cells in the stomach. And so when the food leaves the stomach, it enters the small intestine. And the small intestine, also known as the small bowel, has three parts. Duodenum, jejunum, and ileum. And I remembered it in medical school as dogs jump in. Don't ask me why, but that was my mnemonic for duodenum, jejunum, and ileum. And each part of the small intestine has a specialized function. So the duodenum is close to the pancreas. It's connected to the gallbladder. That's where a lot of the bile is released from the gallbladder. That's also one of our organs. And that bile helps to emulsify fat. It's kind of like if you have a greasy plate and you're trying to wash it and it's not getting clean, but then you put some dishwashing liquid on it and all of a sudden it's squeaky

• 15:56Speaker 02

  clean. So the dishwashing liquid emulsifies the fat so you can get it off the plate. Well, some of these enzymes and some of these substances like bile, bile emulsifies the fat so it can be absorbed through the gut lining in the duodenum. The jejunum has all kinds of specialized functions, too. The ileum, which is the last part of the small intestine, remember dogs jump in, before the large intestine, also called the large bowel, also called the colon, just to confuse you. That ileum is the last part that connects it. And that's where a lot of important things are absorbed. For example, B12 is absorbed in the ileum. Those bile salts that are released from the gallbladder and travel all the way down and emulsify the fats, they are recycled through the ileum.

• 16:41Speaker 02

  And then we get into the colon. And the colon has many parts. It has a cecum, which is a part that's joined to the small intestine. It has an ascending colon that goes up on your right side. It has a transverse colon that goes across, then a descending colon, then a sigmoid, then a rectum, then out the other end. So the really key thing about it is that it's specialized along every inch. The cells are different. For example, the cells lining the esophagus are completely different. They're squamous cells and they are not resistant to acid. And so that's why if you get acid in the esophagus, that's a problem. You get reflux. The cells in the stomach are columnar cells and they are resistant to acid because you're supposed to have acid in the stomach.

• 17:24Speaker 02

  So you have all these different sort of specialized areas of the intestine and they're all important and they all do different things. And then the microbes are different in different areas. So in the upper GI tract, we have much fewer microbes than in the colon because the colon is where all the fermentation happens. And so that's where we're supposed to have all the microbes. One of the things that happens is people take these acid blockers, proton pump inhibitors, and they mess up the pH of the gut and they completely disrupt that gradient. So there's so many things that people do unknowingly, like, oh, I'm having reflux. I'm going to take an acid blocker. They don't think about the consequences of what that means for your pH gradient and the balance of the microbiome.

• 18:05Speaker 02

  And again, back to mental health, we're seeing that so many of these medications that people take or things in the food, like artificial sweeteners and emulsifiers and things like that can really have a profound impact on the gut and they can have a profound impact on the brain. I mean, we're seeing all these studies on ultra-processed foods, particularly in kids. A lot of that work was done by Dr. Montero in Brazil. I'm not suggesting that you can get rid of mental illness in teenagers using food, but there's a whole new field of nutritional psychiatry. People like Dr. Drew Ramsey and Dr. Uma Nedu are really at the forefront of that, of looking at how can we use dietary therapy in conjunction with pharmaceutical therapy, not necessarily instead of to really enhance and optimize mental health.

• 18:50Speaker 02

  And, you know, in some of the studies, it's really profound because some of the food studies have better results than the pharmaceutical studies.

• 18:57Dan Harris?

  Uma, by the way, has been on the show. I'll drop a link in the show notes to that.

• 19:00Speaker 02

  She's great.

• 19:01Dan Harris?

  She is great.

• 19:05Dan Harris?

  Coming up, Dr. Robin Chutkan talks about why we should approach this whole topic with some wariness. We go deep on acid reflux, something I have long struggled with. We talk about the downsides of chewing gum, and she gives us some very simple lifestyle practices that we know from the evidence can promote microbial balance.

• 19:30Dan Harris?

  So before we get to the tips, let me just ask you one last question, which is, you've said this, so I'm not telling you anything you don't know, or I'm not presenting this observation as if it is original. When it comes to gut health, my sense is there's a lot of snake oil out there. There's a lot of overpromising, a lot of hype. And so why should we approach this subject with some wariness? And how bad is the snake oil?

• 19:51Speaker 02

  The snake oil is terrible. It's terrible. There is so much selling and this idea of hacking. And the analogy I like to use is if you are planning on running a marathon, you might get new shoes and cool shorts, and you might even take some protein powder, but you are not going to get to 26.2 miles with protein powder. You've got to put in the miles. But when it comes to gut health, people seem to feel like, oh, I'm just going to take some zinc and glutamine and the right probiotic, I'm going to rub it all together, and it's going to fix my microbiome, it's going to zip up the gut lining, it's going to rebalance things. And I've been around a little while, Dan. I finished medical school in 1991, and I finished my GI training in 1997. So I've been a physician for over 30 years and a practicing gastroenterologist for

• 20:36Speaker 02

  around 28. And I will tell you that the snake oil is insane, because 20 years ago, or even 10 years ago, there were folks out there who were taking stuff. But now, everybody is taking stuff. And the problem is, a lot of these things that they're taking are actually part of the problem. I see people coming in, and they're taking all these different substances, multiple powders, protein powders, collagen powders, and they have GI distress. And often, just by getting them to stop this stuff,

• 21:08Speaker 02

  We're seeing improvements in their GI tract. So what I tell people is, you know, when somebody tells you who they are, believe them, as Maya Angelou famously said. So when it says on the bottle, this product is not designed to treat, cure, any disorder, believe it. This stuff is not tested for safety. It's not tested for efficacy. And the gut is a really tender organ. All these things that you take, I mean, you're taking them by mouth. You are ingesting them. They are traveling through the gut. And so many of them are, again, they're disrupting the gut lining. They're messing up your microbiome. They're changing the pH. And then they also have to be metabolized through your liver, which is another tender organ, especially if you're taking medications or you drink alcohol regularly.

• 21:52Speaker 02

  Some of them are excreted through the kidneys. So we see a lot of problems. We had a situation several years ago with a young woman who ended up with a liver transplant because she was taking so many different supplements that her mother had recommended. So I don't know what it is right now. Certainly, the idea that a lot of these things are originating from the gut, whether it is a mental health struggle or, you know, an immune system that's not functioning correctly. This is true. A lot of time it is, but the answer is not, oh, I'm going to take a pill and fix it. The answer, most of the time, is to say, what am I doing that is disrupting this incredible system that I was born with that the default setting is for it to work? Am I taking too many antibiotics?

• 22:37Speaker 02

  Am I using too many artificial sweeteners? Am I taking an acid blocker? Am I not getting enough fiber rather than let me add something? So I'm a huge advocate for really using this feedback. Our gut gives us incredible feedback, whether it's constipation, or smelly gas, or bloating, or discomfort, or reflux. So what can I do with this feedback? And if you think about something like reflux, the foundation of treating reflux is lifestyle modification. So It's not taking an acid blocker that is literally going to disrupt your gut pH, imbalance your microbiome, put you at risk for bone disease and kidney disease and all kinds of things, long term, and also make you more susceptible to viruses. By the

• 23:21Speaker 02

  way, we had a very important study that showed people taking that kind of acid suppression are two to fourfold more likely to be infected when exposed to a virus because they block stomach acid. And stomach acid is one of our main defenses for when we ingest a virus. So rather than doing that, which yes, it's going to get you some symptom relief, but at a cost, maybe we should really ask ourselves, hmm, how much coffee am I drinking in the morning? That's going to cause reflux. How much alcohol am I drinking? That's going to cause reflux. How much chocolate am I eating? That's going to open up the sphincter. Am I eating too large a meal that is overfilling my stomach and stuff is coming out? Am I eating too late at night because a GI tract is tied to the light dark cycle? So once

• 24:06Speaker 02

  the sun sets, it's pretty much gone to bed. Am I eating too much fat in my meals, which slows down the stomach emptying? So, you know, not to take away everyone's fun of coffee and chocolate and eating something late at night, but again, it's a really important feedback. And what do we do? We're like, oh yeah, I'm not going to listen to that. I'm just going to block stomach acid and mess up my digestion and hope for the best. So I'm so glad you brought that out because clearly people are struggling and they're looking for answers. And, you know, to be honest, Dan, I kind of blame conventional gastroenterology. I'm a conventionally trained gastroenterologist and we spent a lot of time just scoping people because it's really lucrative doing colonoscopy compared to sitting

• 24:51Speaker 02

  down in the office. And, you know, if I mention the reimbursement, what gastroenterologists make on the facility fee, the physician fee, the pathology, the anesthesia, I'm just being very honest here, it is thousands of dollars versus, you know, I might get reimbursed $125 to sit and chat with you for an hour and try and solve your problem versus I'm making several thousand dollars doing a colonoscopy. And that's just a reality. Not to throw shade on my GI colleagues who are mostly wonderful people and colonoscopy does save lives looking for colon cancer, but we're doing this sort of disproportionate number of procedures and we're not paying attention to these problems people are having.

• 25:32Speaker 02

  And so the gaps have been filled in by people saying, oh, I have a zinc supplement to sell you and, you know, here's a gut restore. And I mean, it's crazy. I, as you probably know, launched a gut bliss podcast last year, and I will tell you that every week I get at least a dozen and usually 20 or 30 solicitations from these companies of, you know, oh, we want to, you know, support your podcast. And I'm really proud to say that I, I resist because I, I'm just not going to participate in the selling of snake oil.

• 26:06Dan Harris?

  There may be some disambiguation that's worthwhile here. Like on the one hand, I think of snake oil as disreputable people, dishonest people selling you things that you don't need that not only is a waste of money, but also could have deleterious impacts on your health. Then the other hand, there are sort of misguided or financially motivated moves made by the medical community, people who are credentialed and have taken an oath. And so, for example, you talk about acid blockers, and I could be mixing things up here, but I've had reflux and have been prescribed, what I think Protease pump inhibitors or something like that.

• 26:45Speaker 02

  Proton pump inhibitor, right. Like Nexium or one of these drugs.

• 26:48Dan Harris?

  Yeah. So is that an acid blocker?

• 26:50Speaker 02

  Yeah, that's a proton pump inhibitor.

• 26:52Dan Harris?

  Okay.

• 26:52Speaker 02

  It's an important distinction because the motivation behind it is important. So, you know, I get really sort of zealous about this. So I'm glad that you qualified that. A lot of the people who are pushing these supplements are not healthcare practitioners, and maybe they don't know that the supplement works. They feel like, oh, this seems like a great idea. I'm going to try and push this enzyme. So I give them a little more of a pass than I do somebody with a medical background. But either way, the gastroenterologist who's prescribing the proton pump inhibitor. That's going to solve your problem, likely. That's going to make your reflux better, but at a cost. So it's not that it's the wrong thing.

• 27:37Speaker 02

  It's that they're starting at the top of the pyramid, when they should be starting at the bottom of the pyramid, with some basic diet and lifestyle habits. And I'm not talking about necessarily turning people into a teetotaler, or saying you could never drink coffee, but maybe cutting down from three cups to one. Having one glass of wine instead of two, having it earlier, having smaller meals, eating earlier, swapping out your big meal for lunch instead of dinner. Those are really basic things, rather than the first thing I'm gonna do is I'm gonna say, yeah, you have reflux, take this pill. And I'm not gonna tell you that, by the way, this pill is going to make you twice as likely to become infected if you get exposed to a virus like SARS-CoV-2. This pill is going to really disrupt your digestion

• 28:22Speaker 02

  to the point where you may become iron deficient, et cetera. You're not gonna be absorbing nutrients properly. So I think we're just not using these things judiciously. These are fantastic drugs. I mean, proton pump inhibitors are really good at what they do. They're just overutilized.

• 28:38Dan Harris?

  It's wild to think about, just very personally, and I'm gonna move on from this because it's, I think, a little local to me, or to anybody who has reflux. But I've had reflux for 20 years, and nobody's ever had the conversation with me that you're having with me. And I've seen many, many doctors, and it's always about, do this next scope, do this next test, do this, take this pill, et cetera, et cetera. Okay, let's move on.

• 29:01Speaker 02

  Well, Dan, wait, but wait, but people want us to solve your reflux right now. So tell me, like, a little bit of, you know, not, I mean, this is better than erectile exam, right, for sure? We're just talking about reflux because we're not in the same place. So that's not possible. But in all seriousness, are you a coffee drinker?

• 29:18Dan Harris?

  Nope, I don't drink coffee, I don't drink alcohol, I don't eat chocolate.

• 29:21Speaker 02

  What time do you have dinner?

• 29:23Dan Harris?

  Uh, usually six or seven.

• 29:26Speaker 02

  Okay.

• 29:26Dan Harris?

  It's rare that it would be later than that.

• 29:29Speaker 02

  Is that your biggest meal, usually, dinner?

• 29:31Dan Harris?

  Yeah, I think it is my biggest meal. That's probably a problem. But I can get, if I eat a lot of lunch, I can also get reflux. And it's not that bad. And it's usually, honestly, the thing that makes it go away is sugar-free mint gum.

• 29:46Speaker 02

  Well, mint can be really helpful, but I don't love the sugar free because those artificial sweeteners also disrupt your microbiome. But you're like an A minus because no caffeine, no alcohol, that right there is huge. That's going to eliminate reflux for most people. No chocolate. I don't know how you do it, but kudos to you for that, too. So you're doing-

• 30:05Dan Harris?

  Just to be clear, I love chocolate, but it doesn't love me back. I have panic disorder and there's caffeine in the chocolate, so it makes me anxious.

• 30:12Speaker 02

  Yeah. And the caffeine also opens up that lower esophageal sphincter. So you're killing two birds. So it sounds like the issue is a capacitance issue. Like, once your stomach gets pretty full, and that can happen earlier in the day at lunch and at night. So have you found that you're managing that? Like, are you eating smaller meals?

• 30:32Dan Harris?

  No, no.

• 30:33Speaker 02

  Not really? But what's happening with the reflux?

• 30:36Dan Harris?

  Well, I still have it, but you know, I went and got a test where they actually like have you drink something and then they watch it go through. That showed that I didn't really have bad reflux. So I don't know what that, what that means. It's definitely not a severe case. And like I said, if I have some mint gum, it goes away.

• 30:54Speaker 02

  Yeah. Well, it's good they did that test because the scope shows the damage if you have reflux, but it doesn't show whether you have reflux. So it sounds like you probably had something like a 24 hour pH test where they check and see how much of the time the acid is coming up. The other test that can be helpful is something called a gastric emptying study where they see how long it takes for your stomach to empty. Those are helpful tests. So it sounds like your gastroenterologist were doing some good evaluation. But that's really important because you don't want to be taking a drug like a proton pump inhibitor if you don't have reflux, because again, the drugs can be so disruptive.

• 31:30Dan Harris?

  I took them and it didn't work. So I stopped and now I live with it and it's not a huge problem. And it really depends on what I eat. If I eat kind of crappy food, it's way worse. If I eat super healthy food, it could still be there. Like I had a salad for lunch and I have a little, like a tiny bit of reflux and I chew a stick of gum and it goes away. But I'm curious about sugar free gum because I chew a lot of gum and that sounds like a bad thing to do.

• 31:57Speaker 02

  Yeah, it is because of the sugar free. So the artificial sweeteners, we know are really disruptive to the gut. And you know, the interesting thing about artificial sweeteners for people who might be using them for weight loss is that we know insulin is released not in response to calories, but in response to sweetness. And we know that artificial sweeteners, as we call them, non nutritive sweeteners are plenty sweet. So even though if you burn those calories in a lab in a calorimeter, it may be low or zero, it doesn't mean that when you drink that stuff, you're not gaining weight. So if we look at something like a diet soda, a typical can of diet soda, it might say zero calories, but a typical soda is somewhere around, I think 150 calories.

• 32:40Speaker 02

  Times 365 days and then divided by 3,500 calories in a pound. It works out to about 15 and a half pounds a year. And so a lot of those people are drinking diet sodas thinking, oh, this is great. This is free are actually experiencing weight gain because they're having insulin release from the diet soda. And so I know you're not having the gum for that reason, but what you might want to try is there are some ginger, peppermint and fennel oil capsules that you can try. I'll email you them later, but it's just a little bit of peppermint oil, ginger oil and fennel oil. And those have worked tremendously well for my patients who respond to mint.

• 33:23Speaker 02

  You know, it's really hard to find peppermint gum, any kind of gum without an artificial sweetener. But if you can, that would be great because I think it's a mint that's helping.

• 33:32Dan Harris?

  Interesting. Okay. So let's get to the tips that are for everybody, not just the host exercising his prerogative, perhaps inappropriately. The overarching framework you have is dirt, sweat, veg or vegetables. So let's start with dirt. What do you mean by dirt and how do we operationalize this idea?

• 33:55Speaker 02

  Exposure to nature. So where do we get our microbes? After that sort of prophetic journey through the birth canal, those of us who are lucky enough to be born vaginally, because that's where we get them, right? If you've ever seen a live delivery, if you've ever been present, you see that as a baby's head crowns, as it starts to come out, it turns posteriorly. It turns to face the tush. And that is so that the baby can swallow a mouthful of microbes and get colonized with its own microbiome. So we know that babies who are born via c-section miss out on that and they tend to be colonized with hospital-acquired bacteria, not as healthy. And just that single difference actually puts them at risk, at increased risk for things like allergies and asthma and autoimmune disease later on.

• 34:39Speaker 02

  That doubles if they're not nursed, or increases rather, not doubles. So we know that we get that initial colonization. But then after that, where do we get it? We get it from dirt, from soil. We get it from food that's grown in microbially rich soil. There are studies that show that families that have a dog, the kids require fewer antibiotics, tend to have fewer allergies because the dog is bringing dirt into the home. We know that there are things like the outdoor air factor that refers to the germicidal constituent in air, which means the ability of air to literally kill harmful bacteria, viruses, et cetera.

• 35:20Speaker 02

  So there's a famous study that was written about the Spanish flu about 100 years ago, now about 110 years ago. And it compared the soldiers who recuperated outside in cots versus the ones in the hospital. So of course, the officers were put in the hospital, in a hospital room, to recover while the enlisted folks were just in these cots outside. Well, they had a 40% higher survival because it turns out that this outdoor air is really good for you, for recovery as well as for decreasing your risk. I mean, you remember during pandemic, like, outdoor activities were safer, right? Not just because there's less spread outside, but also this outdoor air factor has to do with it. We know that things like forest bathing, the Japanese call it shinrenyoku.

• 36:05Speaker 02

  That being outside in nature, the plants have not just the phytochemicals that we get when we eat them, but they have these phytocyanins, these substances that the plants themselves use to fight viruses, bacteria, et cetera, fungal organisms, and they release them. You don't have to actually hug the tree or like roll around in the grass. Just being outside in nature is very replenishing to our microbiome. So that's the dirt. Plus, from a mental health point of view, and you know this far better than I do, there is something really profoundly grounding, nurturing, balancing about being out in nature, right? In terms of our brain health too, not just our gut health. So that's a dirt.

• 36:44Dan Harris?

  One thing to say quickly to the listeners, we've done a bunch of episodes on importance of nature as it pertains to mental health and in fact, a three-part series recently with Dacher Keltner. So I'll drop links to those episodes in the show notes. But just on this dirt piece, which is the first of three large buckets when it comes to attacking your gut health. How much time do we need to be spending outside if we care about our gut health? What's the minimum effective dose?

• 37:08Speaker 02

  Yeah, I have to be honest, I'm just making this up because we don't have studies that are sort of scientifically showing that. But I think if you can get outside for an hour, that would be great. But really, if you can literally just open a window, that still does something and let some fresh air in. So you know, the ideal, sure, go roam around in the woods for hours at a time. But if you can sit outside for a few minutes, if you can open a window in your car or your home, it does actually make a difference.

• 37:35Dan Harris?

  Even in the city?

• 37:37Speaker 02

  Even in the city. Now, unfortunately, we have other studies showing that there is a proportional risk of allergies in cities, the more glass and concrete there is, which is sort of a sign of urbanization, right? So the more sort of urban you're dwelling with lots of glass and concrete, not a lot of nature, typically the more allergies we have. We see high rates of asthma in places like New York City and Detroit compared to other parts of the world. But You can still get out. I mean, if you're in New York City, you can still go to Central Park or some other area and benefit from that. We know that rurality is protective against autoimmune diseases. How do we know that? Because when we've looked at studies of kids who grow up on farms

• 38:21Speaker 02

  or exposed to the sort of rural countryside, whether they're farm animals or not, they have lower rates of autoimmune diseases like Crohn's and ulcerative colitis. If you live in a city, you can still benefit from that by visiting those areas, even if you're not exposed to that every day. So those exposures, particularly for children, to more rural areas seem to be really important for helping to train the immune system.

• 38:45Dan Harris?

  We're going through dirt, sweat, veg. We've checked the dirt box. What's to know about sweat?

• 38:51Speaker 02

  I just want to add something to dirt, which is there's a wonderful book called Nature Deficit Disorder. I think it's Richard Muyvie, and the tagline is Last Child in the Woods. For anybody raising kids or really for you raising yourself, it really talks about not just, okay, you're inside on screens and that's a problem, but this idea of a nature deficit disorder and what it's doing to our bodies and our minds. Okay, we're moving along to sweat, and that just means moving your body. And we do have data on that 30 minutes, ideally, minimum of five times a week. And that's because the gut motility is really key for maintaining

• 39:31Speaker 02

  a healthy microbiome. So we don't want stagnation of the products of digestion and the microbes, because then you get overgrowth and things start to go awry. We need things moving. We need the microbes digesting the food, fermenting the food, and then moving out. A large component of our stool is dead bacteria, and we need that to happen. And so if you are sedentary and you're not sort of moving regularly, I always like to say if you're not moving, neither are your bowels. So we know it's important, not just for bowel regularity in the bathroom, but also for this idea of maintaining a healthy microbiome, which really relies on gut motility. And ironically, even though Perry and post pandemic,

• 40:15Speaker 02

  lots of people are working more remotely and have more time. I know I'm in my office a lot less and at home more, but I'm also sitting in front of a computer a lot more. As opposed to being in my office, when I go out to the waiting room, I get a patient, I come back, I take him to the exam room, constantly moving and getting up and back from the hospital to my office. And now I'm spending really long blocks of time just sitting at a computer. And I can tell from a gut motility point of view that this isn't agreeing with me in simple things like tolerating less food because I eat and then I'm sitting for four or five hours. And I feel it sitting there. The movement is really important, not just the sweat, as in go do some sort of intense exercise for half an hour or an hour,

• 40:59Speaker 02

  but just a regular movement. It keeps things going. There's something called the migratory motor complex in the gut, the MMC. And that is important to be stimulated for proper gut motility and digestion. And, you know, sitting for long periods of time really kind of disrupts that.

• 41:16Dan Harris?

  I mean, the case for exercise just gets stronger all the time. I'm a big believer. Okay. Vegetables. And this is basically your shorthand for diet.

• 41:27Speaker 02

  For diet, for fiber, yeah. So in 2018 or 19, there was a study done called the American Gut Project. And this was the largest study ever done, looking at the human microbiome and asking the basic question, what does it take to create a healthy microbiome? It was done by Rob Knight, who's a PhD, really brilliant microbiome researcher and others. And they looked at over 10,000 people from over 40 different countries. And this is really important because a lot of the other microbiome studies looked at 20 white men in Olmsted County, Minnesota, and we extrapolated to the entire world from there. So this looked at men and women and older and young and different ethnic groups from 40 different countries.

• 42:08Speaker 02

  And what they found was that the single most predictive factor for a healthy microbiome was the number of different plant foods you ate in a week. And the interesting thing here, Dan, is that it didn't matter whether people identified as vegan or pescatarian or vegetarian. There were vegans who had really unhealthy microbiomes because they were eating fewer than 10 different plant foods per week. And they were omnivores who ate a very sort of animal protein heavy diet, but also ate tons of plant foods. And when I say 30 different plants, it's not 30 different vegetables. So that includes fruits, vegetables, nuts, seeds, whole grains, herbs, spices, all of it.

• 42:51Speaker 02

  And I always like to think about my husband's oatmeal in the morning. He makes oatmeal. He puts in it walnuts, pumpkin seeds, raisins, blueberries, shaved coconut. And that's six things plus the oats. And you can keep going. You could put in a little dash of cinnamon, all of that. You even get credit for a little bit of maple syrup. So if you think about a salad and you're starting with a basic base of some maybe lettuce and cucumber, and you add tomatoes, and you add some pickled vegetables, and some shaved Brussels sprouts, and some carrots, just keep going. So really, what I want people to think about is a variety, not the quantity. You can eat two strawberries and you're getting lots of healthy nutrients and things like lycopene from the strawberry.

• 43:36Speaker 02

  So it's not about eating a massive salad. It's really about the variety and trying to throw some things in there. And again, some herbs, spices, all of that stuff is really important for creating diversity in the microbiome. So if we want to have a diverse microbiome, we need to eat a diverse diet. And that's why this 30 different plant foods is such an important recommendation.

• 43:59Dan Harris?

  What are the three Bs?

• 44:01Speaker 02

  The three Bs are beans, broccoli, and berries. And that's just sort of my shorthand. I mean, it happened to be three things that I really like. But rather than thinking about, oh, you know, soluble fiber and soluble fiber inulin, all these different things, think of beans, think of berries, and think of broccoli. Or broccoli like foods. If it's broccolini, or if it's, you know, Brussels sprouts, that's close enough. But think about those dense fibrous vegetables like...

• 44:31Speaker 02

  The broccoli and the Brussels sprouts and don't throw the stems away. That's where most of the fiber is. So you want to chop up those stems and make sure that you're you're eating them too. Cooked, sauteed, however you're doing them. The berries, any kind, and don't get hung up on frozen. What I just eat some berries. And of course, beans, any sort of legume is really fantastic for the gut microbiome. And the reason these things are important is because they have large amounts of poorly digestible or indigestible fiber in them. And it's indigestible because it's not meant for us. It's meant for our gut microbes. And so when that fiber hits the colon, it gets fermented by bacteria into these short chain fatty acids. And short chain fatty acids are really important post metabolite.

• 45:14Speaker 02

  Sometimes we call it a postbiotic, something that bacteria create. And they help to maintain the lining of the gut. They help to balance our immune response so that we don't have an overblown response. And to show you how profound this is, Dan, there was a study out of UMass Amherst that was done in around 2021, right sort of middle of the pandemic. And it looked at a stool sample as a marker of COVID outcome. And it found that the proportion of healthy bacteria like fecalibacteria and prospinitiae, which we see primarily in people eating a high fiber diet, regardless of whether they're fully vegan or not, just eating lots of fiber every day, high levels of that predicted

• 45:57Speaker 02

  COVID outcome with 92% accuracy. That's more accurate than all the lab data and, you know, whether you have a comorbid disease, age, et cetera. So we can predict outcome as in mild infection, no infection, ventilator, death. 92% accuracy based on what your microbiome looks like. And what your microbiome looks like is most profoundly impacted by what you're eating. I tell you, Dan, I struggle with this because I would see patients from all over and I think patients are like, oh, we're coming to see this fancy gastroenterologist and she's going to crack the case. And I'm sitting there thinking, how do I make eat more vegetables?

• 46:40Speaker 02

  Get out in nature and move your body. Sound like it was worth this trip from California or wherever it was, right? And by the way, could we throw out all these supplements you're taking? And let's really reconsider the medicine cabinet because you're on a lot of medications. Several of these might be disrupting your gut. So let's see if we can work with the prescribing doctor and figure out which of these are absolutely necessary. So that was always my challenge, right? Is how to make this stuff sound more enticing.

• 47:12Dan Harris?

  Just some follow up questions. You said before, I'm not trying to say you should never have chocolate. You should never have a glass of wine, et cetera, et cetera. You're selling us, I think, very effectively on the benefits of a healthy diet. How do we think about cookies and pasta and bread dipped in olive oil and candy at the movies in this context?

• 47:35Speaker 02

  Well, I think we have to separate foods. I mean, there are treat foods that are not ultra processed foods. And for anybody who's not familiar with a NOVA classification, NOVA, it doesn't stand for anything. It's not an acronym, but developed by Dr. Carlos Montero and his colleagues. It is a one to four classification for foods that goes from category one. These are pretty much unprocessed foods. They may be ground up or something all the way through to category four, which are ultra processed foods. I did a podcast episode on this also, sort of brief primer on ultra processed foods. And ultra processed foods are really problematic because they are messing up our gut. They are messing up our brains. They are associated with an increase in mortality.

• 48:19Speaker 02

  You are more likely to die if a significant proportion of the food you're eating are ultra processed foods. And in the U.S., we're now at about 55%. About 55% of our calories are from ultra processed foods. And it's particularly a problem in children because we know that these edible food like substances, as I like to call them, are associated with issues around executive function, cognition, et cetera. And I have to say, you know, I'm super proud of people, Food Babe and Jillian Michaels and all these folks who are out there trying to get food dyes out, et cetera. But I want to also point out, like, I don't think a healthier Fruit Loop is the answer. Like, don't eat Fruit Loops as your main food group.

• 49:04Speaker 02

  Once a year or something, you know, you have something, okay, it's a treat, I'm eating this. But putting in a different kind of food coloring into the Fruit Loop is not the answer. We have to recognize that Fruit Loops are an ultra-processed food, no matter what is in them. And if you want a really great dive into that, Chris Van Telekin's book Ultra Processed People is really fantastic. So I would put categories like the candy you're gonna get at movie theater and the breakfast cereals like Fruit Loops in a separate category from a really good bread that was made, maybe by a local bakery or something, and the ingredients are all things that you would recognize. It's not a chemistry experiment.

• 49:46Speaker 02

  It is things like wheat and eggs and milk and so on. And if you don't have any issues with those, if you're not dairy intolerant or gluten intolerant, you know, a whole made

• 49:58Speaker 02

  loaf of bread that was made by somebody and not made in a factory, ideally, or not in a big factory and in a big sort of industrial process, is actually fine to eat. Or some ice cream that's not full of emulsifiers. But again, that's not your main food, right? That's a treat. But that's really different from the ultra-processed stuff that is really not even recognizable as food. And I still love to think back to Michael Pollan's Food Rules, you know, eat food with less than few ingredients, eat food that your grandmother would recognize as food. When I start reading these ingredients to people, I say to them, if I took you into a chemistry lab and I told your kid, "Open up," and I mixed in a beaker all these different chemicals that you've never heard of

• 50:43Speaker 02

  and you certainly don't have in your kitchen, and I said, "Open up," they would run out of there. But a lot of these things are what we're feeding our kids, and it's because the front of the packet is all marketing. The front is like, oh, it's, you know, high fiber and it's low sugar. It's low sugar, but it's full of artificial sweeteners. So it's all this sort of advertising on the front, right? And then on the back is where you really need to pay attention to the actual ingredient list. And you start seeing stuff. My rule of thumb is if this is not an ingredient that you could possibly have in your kitchen or in your pantry somewhere, don't eat it.

• 51:22Dan Harris?

  Here's the way I think about this, and I say this for your reaction. I've been deeply influenced by a woman named Evelyn Tribbley, who's one of the progenitors of intuitive eating. And she was trained as a nutritionist, but her idea is that if you get too obsessed, which is something I did for much of my life in an orthorexic way, too obsessed with eating healthy, you're not listening to your body anymore. And so now, generally speaking, I know what's good for me, quote unquote, and I eat a quite a healthy diet. But also, most days, I'll have a little dessert after dinner. And if I go to the movies with my son, which isn't that frequent, we'll have some candy. So it's kind of best of both worlds. I know what makes me feel good, and it's not candy and Oreos.

• 52:07Dan Harris?

  But I don't rule them out entirely. And I live my life in a reasonably easeful way in this manner.

• 52:13Speaker 02

  100% agree. 100% agree. My daughter's in college up in Hanover, New Hampshire, and we usually fly, but sometimes there's a road trip. And one of the first things I do is I go buy a bag of Cheetos. Now, I recognize, I don't even know what food group Cheetos come from. I mean, I think there's corn in there somewhere. But I recognize that, like, Cheetos, they do not make up the mainstay in my diet. But a couple of times a year, I am eating my bag of Cheetos happily on the road trip. Right? So we have to live in the rail world. And there is ice cream in our house, there is chocolate in our house. We eat that stuff, but the bulk of our diet are foods that actually don't have a long ingredient list on them, or any ingredient list at all. So typical dinner would be lentils and brown rice,

• 52:57Speaker 02

  and some sauteed spinach, and maybe some chicken or fish for me, and not something coming out of a box that goes into a microwave with a long list of ingredients. So intuitive eating is exactly what we should be doing, and listening to our bodies. But because the food landscape...

• 53:15Speaker 02

  Is really complicated now. In our parents' generation, they went to the store, they picked up a pack of chicken. It was chicken. Now you pick up a pack of chicken, it could have 15 or 16 different ingredients in there. You know, you're at a sort of fast casual restaurant or fast food restaurant eating chicken and the chicken has 17 ingredients in it. So one of the ways around this is really just to try and eat at home more, where you are buying the things to prepare the meal out of that don't have a long ingredient list. So you know that your chicken is just chicken, right? It's not injected with a whole bunch of other things. But it's challenging. You know, it's really hard. People are busy. There's lots of time and money spent making us think that these highly processed things

• 53:58Speaker 02

  are actually good for us. And, you know, Dan, I think the people who do have food intolerances, like lactose intolerance or gluten intolerance, they have a harder time because they are looking for gluten free things. And often the gluten free things are worse. They're full of emulsifiers to make it feel or taste like gluten. So what I tell my patients is if you have celiac disease, or you are gluten intolerant, or you just decided you want to give it a try, not eating gluten and see how you feel, don't buy anything that says gluten free on it. Because potatoes don't say gluten free, and rice doesn't say gluten. Those are just naturally gluten free things. So if you just veer towards the whole grains, like quinoa, or rice, or oats, or things

• 54:39Speaker 02

  like that, it's not like a gluten free pancake, or gluten free cookies, or that's when we really get into trouble, when we start trying to create a version, or artificial sweeteners, like we talked about with the soda earlier. So the idea is if you are diabetic, or you're struggling with weight, and you want to have less sugar, have less sugar. But don't have something artificially sweetened. And have a little sugar, but put less of it in. So really try to steer people away from these sort of synthetic, artificial versions of actual food, that from a marketing point of view seem really appealing, but are really sort of messing up our chemistry in lots of different ways, some known and some unknown.

• 55:24Dan Harris?

  Coming up, Dr. Robyn Chutkan talks about the importance of looking at your poop, bloating, and distinguishing belly fat from bloat, why not all gas is bad, and whether there are actually good supplements to consider.

• 55:45Dan Harris?

  Okay, so we've pushed this off long enough. Let's talk about another big, practical thing that we should be doing when it comes to our gut health, and that is examining our poop.

• 55:57Speaker 02

  Turn around and take a look. Did you turn around and take a look today, Dad?

• 56:01Dan Harris?

  Yes, because I prepared for this podcast and I knew you were gonna ask me that.

• 56:04Speaker 02

  And what do you have to tell me?

• 56:07Dan Harris?

  Oh, my God.

• 56:09Dan Harris?

  Am I doing this on, in public?

• 56:12Speaker 02

  Well, you don't have to show us. You just have to tell us.

• 56:17Dan Harris?

  Based on what I read from you about what you want to be seeing, I believe I saw that.

• 56:22Speaker 02

  You have achieved stool nirvana. I believe it. I think you have. I think you have. You, you look like you have.

• 56:32Dan Harris?

  Thank you. I appreciate that. I don't know how, what that means, but sure.

• 56:35Speaker 02

  So, a nice brown color, like not too light, not like sort of that chocolatey brown, varying towards a darker brown?

• 56:44Dan Harris?

  Mm-hmm, yeah.

• 56:45Speaker 02

  Nice, good width. I mean, maybe not quite the width of your arm, but like good heft to it. Banana? At least a banana-type diameter?

• 56:56Dan Harris?

  I don't think so.

• 56:56Speaker 02

  Not quite a banana?

• 56:57Dan Harris?

  Banana-type diameter. How does that even come out?

• 57:02Speaker 02

  That actually leads to the conversation around consistency. So, we were talking at the top of the hour with your producer about the Bristol stool scale, one through seven, with one being really small, hard lumps. And then, as you get down into five, six, seven, more loose, into just sort of purely unformed stool. So, ideally, if you're somewhere around a three, four, five, the stool has some bulk to it, but it still passes out because it's not hard. And at the same time, it's got form to it. It doesn't fall into the bowl and sort of disappear. But, you know, really, just the fact that you are looking is fantastic. And kind of like the intuitive eating, I love the idea of intuitive pooping, which

• 57:42Speaker 02

  I'm gonna give you credit for, that it doesn't have to be like a fantastic A-plus bowel movement champion. Every time. First of all, you're even going regularly, like, that's important. And that sounds like that's the case. And it's got a good color. It's coming out. It's not painful. It's not falling apart. It's not also looking super odd or the odor. I mean, nobody's stool. And I've been up inside thousands of colons and have many pictures of people's bowel movements on my phone that they have generously shared with me, HIPAA protected, of course. And I'll tell you that nobody's stool smells fantastic.

• 58:27Speaker 02

  But you know when your stool is off, like if you've ever had food poisoning or you've just been like eating terribly, you know, right? You know what the regular odor is and you know, like, hmm. And this leads me to this predicament I have all the time, which is, you know, for dentists, like, they have to show up with like a beautiful grill, right? Dentists have to have really good teeth because people walk into their office, they don't want to see a dentist with like crooked yellow teeth. And dermatologists, that's, oh, that's a lot of pressure. You walk in, you know, you want the dermatologist, it's supposed to look all like smooth and flawless skin. But people walk into my office, they don't know what my bowel movements look like. I mean, they happen to look great, but they don't know.

• 59:11Speaker 02

  So here's a, here's a problem I have and my poo pride. If I am somewhere like this yoga studio, I love Down Dog Yoga in DC, and I'm there waiting for the class and I go into the bathroom, and let's just say I go into the bathroom to pee or wash my hands. But somebody before me has been in there and they are not experiencing stool nirvana. They are have like some horrendously foul stool. And maybe it's even left some marks in the toilet. I mean, really bad situation, terrible odor. And I come out. Then the person who's going in next after me, I want them to know that is not my stuff. That is not, I did not do that. And it seems so foolish, right? Cause like, what do you care? But that's a pride I have, maybe like with a dermatologist's skin.

• 59:56Speaker 02

  It's to the point, Dan, where I have gone to use the bathroom and I'm come out. I'm like, no, because I cannot have this line of people behind me. And like, there's somebody from yoga, my friend Wolfgang or somebody I know right behind me. He cannot go in here thinking that this is my poo situation. So this is my poo pride that I struggle with.

• 1:00:18Dan Harris?

  Setting aside your situation for just a second, it's gonna smell bad, but if it smells like so foul that it's unusual, that's a bad sign.

• 1:00:26Speaker 02

  Yeah, that's a bad sign. And that doesn't necessarily mean, you know, you have a parasite or something terrible, but it could mean that you're eating more processed meats, for example, things like bacon and sausages and deli meat that sometimes contain compounds that will give it a rotten egg type smell. There are things that I know I eat a lot of beans and beans can give you gas. And so the gas itself is not necessarily a problem. But if the stool itself smells really off, if you've been on antibiotics, sometimes that can affect the odor. Certain supplements, a lot of the supplements we talk about that people are taking that are not that great for them can change your odor. So it's important to really pay attention to that. And the most important thing that you're looking for is blood in the stool.

• 1:01:12Speaker 02

  Because blood in the stool, while it's often something benign like a hemorrhoid or a fissure, blood in the stool can also be a sign of colon cancer. And we're seeing more and more colon cancer in young people, even though we've moved that age of screening from 50 to 45 for everyone. We're seeing colon cancer in teenagers, in people in their twenties and thirties. And so if you have a change in your bowel habits, particularly one that's not explained by a dietary change, with a change in the consistency of the stool, the size of the stool, the color, the shape, or anything that looks like blood, you definitely want to get that evaluated.

• 1:01:48Dan Harris?

  How many times a day should we be moving the bowels?

• 1:01:52Speaker 02

  At least once. Our GI definition of constipation from the gastroenterology field says fewer than three times a week is constipation. But really, we eat every day. We should be having a bowel movement every day. That's sort of a generous definition that if you're going four times a week, you're not constipated. But what we're seeing as sort of the modern day version of constipation is something called incomplete evacuation.

• 1:02:18Speaker 02

  Which is you go, but you are sorely disappointed by what's coming out. You go, but only a little bit comes out and you can feel that there's more in there waiting to come out. I liken it to insomnia.

• 1:02:29Dan Harris?

  Yeah.

• 1:02:29Speaker 02

  Because I think the modern day version of insomnia is you fall asleep, but then you wake up and you can't go back to sleep. Right. So it's not that you don't fall asleep. It's that you're waking up and you can't go back to sleep. So again, it's not that you're not having a bowel movement, but it's incomplete and it's stingy.

• 1:02:45Dan Harris?

  So if you're having bowel movements three or four times a day, that might be a problem because each of them is insufficient.

• 1:02:53Speaker 02

  Exactly. Or it may be that particularly if the stool is loose or softer, it may be because you are not reabsorbing all the water from the colon back in to result in a formed stool, firmer stool. And that can sometimes be a sign of things like colitis, of inflammation in the colon. So particularly a change. If you eat a really high fiber diet and you exercise a lot and you stay hydrated and you move your bowels a couple of times a day and you always have and you feel absolutely fine, generally not a problem. But if you have been sort of a want a day kind of person and now you're going two or three times a day, and particularly if there's a change in the stool consistency, that's definitely something that you should be looking into. And it doesn't necessarily mean it's something serious like colitis.

• 1:03:37Speaker 02

  It could be a food intolerance. It could be that now you're not tolerating dairy as well.

• 1:03:43Dan Harris?

  You mentioned bloat earlier. What is that and why is it important?

• 1:03:49Speaker 02

  Bloat refers to abnormal distension. Generally, we're talking about the abdomen when we talk about bloating. And that abnormal distension can be with any sort of air or gas. It can be with liquid or it can be something solid. And so one of the things that I'm frequently trying to help people with is distinguishing between, is this belly fat or bloat? And the key distinction there is that belly fat doesn't come and go. Right. So I'll tell people, take a tape measure, measure abdominal girth in the morning, in the evening for several days. And if you see that number's not really changing, that's probably that you've put on more weight around your midsection belly fat. If you're seeing a variation, you know, couple inches difference between morning or evening or from day to day, that's more bloating.

• 1:04:34Speaker 02

  But most people can tell, you know, they can tell belly fat from bloating. I'll tell you, Dan, I would say somewhere north of 50%, probably 60 or 70% of bloating. Is due to constipation. Is that somebody's just blocked down below. There's a wad of stool down in the colon that is preventing that gas from escaping. And a lot of times people will say, well, I'm not constipated. I go every day. But again, it's an incomplete movement. They're kind of blocking the passage of the gas. So the first thing I generally start with when somebody comes in who's bloated is I really work on a good bowel regimen. Having like a really big, complete evacuation every day. And I would say about half the time the bloating gets better.

• 1:05:16Speaker 02

  And then the other half, we have to look at things like, is this a side effect of a medication? Is it an intolerance to a food you're eating? Is it a motility issue? Do you have a fibroid that's sort of pushing on your colon and blocking things? There's medicine cabinet, there's physiology, there's hormonal stuff with the thyroid. There are anatomical differences. I wrote a whole book about bloating called The Bloat Cure. 101 Natural Solutions for Real and Lasting Relief. It's alphabetical for easy access, but that's just a sort of quick compendium. Each one of those things is a page. But if you're trying to be a bloat detective and figure out, okay, could I have an underactive thyroid? Is it something I'm eating? Is this an ovarian issue?

• 1:06:00Speaker 02

  It's a great little resource to try and help you figure out where your bloat's coming from.

• 1:06:05Dan Harris?

  Just going to sneak in one or two more questions before we run out of time here. Beans, you were just talking about gas and that got me thinking about beans. I was a vegan for five years. That involved eating a lot of beans. I don't actually like beans that much and they really do disagree with me. And my family was not happy with me and the beans. So how important are beans? Do we all have to eat them? And if we do eat them and they give us gas, what do we do about that?

• 1:06:31Speaker 02

  There are a couple of things and I really want to distinguish between what I call good gas and bad gas. So bad gas is like food poisoning, rotavirus infection. It's really typically not just foul, but it is painful a lot of the time and different.

• 1:06:48Speaker 02

  Or lactose intolerance, where you know, you have dairy and there's terrible gas and you have loose stools and you feel really sick. The gas from beans is because the fibrin in beans is poorly digestible. As I said, it's really there to feed our microbes and we lack the enzyme called alpha wong lactosidase that can really break that down. So a simple thing to do is to take a little bit of that enzyme. You can get it in the form of something called bino. There are other forms too. You can also soak the beans overnight ahead of time. You can put in a C vegetable like kombu, but it's pretty simple and there's not really any downside I can think of of taking something like bino. And that provides enzyme. It helps to sort of break that down. But there are other things you can do.

• 1:07:32Dan Harris?

  Before the meal?

• 1:07:33Speaker 02

  Yeah, before or right after, but ideally before. You can eat less beans and then there's some like lentils, maybe not as gas producing for you as black beans. So you could try different ones, smaller portions, but to some extent, there's no completely getting around that for most people because again, those beans are feeding your gut bacteria. And the gas you're experiencing is a side effect of the fermentation process. And you know, hopefully you've been married long enough and your family is sufficiently fond of you that they're not going to banish you completely. But yeah, my husband was vegan for quite a few years also, and we still tend to eat a lot of lentils, a lot of chickpeas. Yeah, there can be some impressive gas as a result of that. That's for sure.

• 1:08:18Dan Harris?

  Supplements, we've been running down supplements in the course of this conversation. Are there any good supplements that we should consider?

• 1:08:27Speaker 02

  There are what I call digestive aids that can be really helpful for people. So for example, fiber. I'm always suggesting, oh, you know, drink a green smoothie, have some beans, brown rice, kale salad, all of these things, but not everybody is able to get in as much fiber as they need all the time, every day. So fiber supplements like ground psyllium husk, P S Y L L I U M, psyllium, which is ground up fiber from the plantago ovato plant. That can be really fantastic for helping to bulk the stool. And also for people who don't tolerate the psyllium husk as well, acacia fiber from the acacia tree can also be helpful. So those are fiber supplements that I frequently

• 1:09:10Speaker 02

  use in my patients. Magnesium supplements can be helpful for laxation, which is sort of the nice word for having a bowel movement. I don't think magnesium is magic. It's been suggested. I don't think it's going to fully relax you and make you sleep and heal your gut, but a little magnesium in the evening, particularly when combined with a little psyllium husk or acacia fiber in the morning, can sometimes be just what people need to get them over the hump and have a really nice bowel movement in the morning. So those are things I recommend for patients all the time. The other thing, there are some probiotics. We don't really have data that the average person benefits from taking a probiotic any more than they do from taking a vitamin, but there are specific cases, post-food poisoning,

• 1:09:54Speaker 02

  post-gastroenteritis. I see a lot of patients with autoimmune diseases like Crohn's disease and ulcerative colitis. And the probiotic I recommend, Visbiome, has been clinically studied in over 100 clinical studies and shown to be beneficial. It has a medical food label on it from the FDA. But for the average person going in and buying a probiotic off the shelf, you are better off buying a little sauerkraut from the farmer's market or doing a little dirt-swept veg. But there are certainly probiotics that are powerful combinations of several different strains that can help in specific conditions, whether it's a traveler's diarrhea, irritable bowel syndrome, people with inflammatory bowel

• 1:10:37Speaker 02

  disease. So I really recommend that people would work with their healthcare practitioner to find something. And usually, Dan, not necessarily the one somebody is selling. That may not be the one. So maybe the gastroenterologist asks them what they recommend. It's not the one like, oh, I have it right here on my shelf. Let me sell this to you. Because most of those probiotics off the shelf, they don't have enough live bacteria, what we call the colony-forming units, the CFU. They don't have enough strains or they're not really doing anything. You're just pooing it right out. And While you could argue, well, that's not necessarily harmful. The problem is, I think it lulls people into this false sense of security that they're doing what they need to do, when really what they need to do is probably pay a little more attention to their diet.

• 1:11:22Speaker 02

  So that's also my beef with a lot of the supplements and the powders and so on is like, you think you're nutritionally replete because you're taking this stuff and you're sort of neglecting doing the real work with the diet.

• 1:11:35Dan Harris?

  Dr. Chuck Yan, before I let you go, can you just remind everybody of the names of your books and your podcasts and any other stuff you've put out into the world that we should know about?

• 1:11:44Speaker 02

  I will. Thank you so much. So Gutless, first book. This is sort of, you know, if you want to be a medical detective and learn everything you can about the digestive tract and your gallbladder and colon, Gutless. Second book, The Microbiome Solution. Very different kind of hair day on this one. That took a lot of work. But this is really all about the gut microbiome and the involvement of the microbiome with autoimmune disease, with mental health, et cetera. So that's much more an in-depth sort of scientific view of the microbiome. The Bloat Cure, A Quickie, 101 Natural Solutions for Real and Lasting Relief. And then the last one, and I have to say probably my favorite, The Antiviral Gut. This book was very difficult to write because I wrote it during pandemic.

• 1:12:29Speaker 02

  It came out in 2022 and I would wake up and there'd be 27 new research papers on the chapter I just wrote the day before. But the basic theme for that is the idea that our digestive tracts are not just organs for digestion, they are our main defensive organ in the body. They secrete acid that helps to denature and sort of neutralize viruses. The gut lining protects stuff in our gut from seeping into the rest of our body. The microbiome, very much involved in our immune system, et cetera. So it's really reframing the gut in the sense of it being a more defensive organ and an important part of your immune system. The podcast is the Gutbliss Podcast and I'm so delighted to have the opportunity to share with you.

• 1:13:14Speaker 02

  I have to tell people a quick story about you, not your bowel movements, but about you.

• 1:13:21Speaker 02

  Gupless had just come out in 2013. 10% happier. See, I have it right on my shelf. I even have a place marked that I was looking at recently. 10% happier had just come out, right? Recently, around that time?

• 1:13:33Dan Harris?

  Yeah, 2014, yeah.

• 1:13:35Speaker 02

  Yeah, so we were all on our way. That was where I met Rich Roll, who's continued to be a wonderful friend and the Sakara Life ladies, Whitney and Danielle, and so many wonderful people. So we're all on our way to Miraval for this grand experiment, My Body Green, of getting all these folks together. Joe Cross, Joe and the Juicer, still really good friends with all these folks. And I saw that you and I were speaking on the same day. I saw your name and I saw your book. So I was like, oh, I'm gonna read his book on the way there because I don't really know his story. And this is a really intriguing title, 10% happier. So I read the book and I think I read it on the plane on the way to Arizona. And I, and you know, it's a, it's a very accessible book. It's a quick read.

• 1:14:15Speaker 02

  And I remember thinking, this guy is an asshole. He like, he's a total dick. Like, I can't believe he's speaking at this conference. Like, he sounds just horrible and, you know, so full of himself. And then I got to the conference and we didn't interact a lot, but we interacted enough. I mean, I was there for your talk and I was like, he's a really nice guy. He is not an asshole. This is, so I just want to tell you, first impressions can be misleading. Have other people said that they read this book and they thought you were not that nice a person from the book?

• 1:14:48Dan Harris?

  No, it's usually the other way around. They read the book, they love the book, and then they meet me and are disappointed.

• 1:14:54Speaker 02

  No, no, I, I loved the book. I just thought you were a little bit of an asshole from the book. I had the opposite. Yeah, I met you and I was like, oh, he's really nice and he's not full of himself at all. And not to overuse the word, but he's really authentic. And I think what you're trying to do, you know, and I watched the episode and I could sort of feel it, like you're, this big thing happened. And for anybody who hasn't watched it, go watch it. But you are trying to figure out, like, how can I bring as many people along with me on this journey for as little as possible? I mean, we all have to make a living, right? But how can I focus on being of support and being of service rather than just making as

• 1:15:36Speaker 02

  much money as I can? I thought it was so lovely and I subscribed.

• 1:15:41Dan Harris?

  Thank you. I appreciate that. And I appreciate your time today. Yeah, I learned a lot, so thank you very much.

• 1:15:48Speaker 02

  I'll be expecting those poop pictures.

• 1:15:52Dan Harris?

  That's not gonna happen, but sure.

• 1:15:59Dan Harris?

  Thanks again to Dr. Robin Chutkan. Awesome to talk to her. I learned a ton there. We've done some episodes that are related to what you heard me discuss with Dr. Chutkan in this episode, and I'm going to drop some links in the show notes if you want to go deeper on this. They include my conversations with the nutritional psychiatrist, Dr. Uma Naidoo, a three-part series I did with Dr. Keltner, the UC Berkeley professor, on the impact of nature on your physiology and psychology. And then I'm also going to drop a link to the Career Earthquake episodes. Two things before I go. First, just a reminder that for this and every episode we're doing this month during

• 1:16:38Dan Harris?

  our Get Fit Sane series, we've got a bespoke companion meditation crafted by my friend and the great Dharma teacher, Cara Lai. Today's guided meditation is called "When You Want to Eat Your Feelings," and it's all about how to eat mindfully instead of mindlessly. I have been working on mindful eating for many years. It is a huge challenge, but absolutely worth it. So go over to danharris.com and become a paid subscriber if you want that meditation in your podcast feed or your inbox. Not for nothing, if you become a paid subscriber, you'll also be supporting me and my team as we launch our new little business.

• 1:17:19Dan Harris?

  Lots of exciting stuff. Second thing I want to do before I let you go is I want to thank everybody who worked so hard to make this show. Our producers are Tara Anderson, Caroline Keenan, and Eleanor Vasili. Our recording and engineering is handled by the great folks over at Pod People. Lauren Smith is our managing producer. Marissa Schneiderman is our senior producer. DJ Kashmir is our executive producer. And Nick Thorburn of the band Islands wrote our theme.