Live Dirty, Eat Clean: Robynne Chutkan, MD on Everything Microbiome

Our bodies are comprised of about ten trillion cells. But our microbiome — all the bacteria, viruses, and fungi that live in or on our bodies – outnumber human cells by a factor of 10. Therefore, it can be said that we are far more microorganism than human. We choose to believe that we are sentient beings, responsible for our health, moods and decisions. But the crazy truth is that to a large extent, our emotional state, propensity for disease and even our specific food cravings can all be traced back to the nature of our gut ecology. Most of these microorganisms are symbiotic. Maintaining a healthy culture of the right microorganisms is fundamental to good health. But should the quality of your microbiome go awry, health havoc ensues. This week on the show we delve deep into the nuts and bolts of this fascinating and quickly evolving field of medicine with respected gastroenterologist, microbiome expert and avid marathoner Robynne Chutkan, MD ( @DrChutkan ). A graduate of Yale, Dr. Chutkan received her medical degree from Columbia College of Physicians and Surgeons in New York, where she also did her internship and residency and served as Chief Resident. She completed her fellowship in gastroenterology at Mount Sinai Hospital in New York and has been on the faculty at Georgetown University Hospital since 1997. In 2004, Dr, Chutkan founded the Digestive Center for Women, an integrative gastroenterology practice that incorporates nutritional optimization, exercise physiology, biofeedback, and stress reduction as part of the therapeutic approach to digestive disorders. Lecturing throughout the United States and Europe, Dr. Chutkan has authored dozens of journal articles; serves as medical consultant and on air talent for the Discover Health Channel; is a member of the medical advisory board for the Dr. Oz Show (where she has appeared as a regular guest); and has also made national appearances on The Today Show, The Morning Show, and The Doctors. Consistently named one of the area's best doctors by Washingtonian magazine, Dr. Chutkan is also the author of two bestselling books, Gutbliss* and most recently, The Microbiome Solution*. Specific topics covered today include: * what is the microbiome? * The regulatory functions of the microbiome * the perils of over-sanitization * why you should avoid a c-section birth * the problem with prophylactic antibiotic prescription * the hygiene hypothesis & modern plagues * the affluence effect & overmedication * the nexus between antibiotics & autoimmune disorders * behavior/cravings influenced by the microbiome * eating disorder impact on microbial makeup * why you should rethink the flu shot * rewilding your microbiome * the efficacy of probiotics & fermented foods * products and environments that disrupt our body’s ecosystems * fecal bacteriotherapy Enjoy! Rich Learn more about your ad choices. Visit podcastchoices.com/adchoices

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

• 0:00Rich Roll?

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• 1:05Robynne Chutkan?

  We really have to rethink what it means to be human and to be healthy and our relationship with microbes. And this idea that the cleaner, the more sterile, the more chemicals we have in our environment, the healthier we are. If you go down that road, you will end up in a really bad place as far as your health is concerned.

• 1:23Rich Roll?

  That's Dr. Robin Chutkan, and this week on the Rich Roll Podcast, it's all about the microbiome.

• 1:39Robynne Chutkan?

  The Rich Roll Podcast.

• 1:42Rich Roll?

  What's up, everybody? I hope you're enjoying your commute. Maybe you're taking the kids to school, you're out running, the gym perhaps, sneaking in a listen at your work cubicle, making dinner, whatever, wherever, whenever. Welcome to the show. Thanks for dropping by. I really mean that. My name is Rich Roll. I am an athlete, author, public speaker, wellness advocate, husband, dad, student, and of course, podcast host. And this is a show where I commune with the outliers, the paradigm shifting, big forward thinkers across all categories of positive culture change, health, fitness, nutrition, academia, tech, consciousness and spirituality. And in the case of today's guest and subject matter, medicine and human biology.

• 2:25Rich Roll?

  The goal is simple, to help all of us unlock and unleash our best, most authentic selves. Good for you, good for me, good for humanity. So, thank you so much for subscribing to the show on iTunes, for taking a moment to give us a review on iTunes, and for always using the Amazon banner out at ritual.com for all your Amazon purchases. We greatly appreciate that. Today, I'm coming at you from Beirut. I'm in Lebanon. Unbelievable. Such a gift. I'm so grateful to have the opportunity to come to these exotic places of the world, to share a message of health and wellness and fitness. But I'll tell you this, I'm super jet lagged. It's Saturday morning around 10 a.m., which makes it midnight back home, 10-hour time change.

• 3:10Rich Roll?

  So I got a little bit of brain fog right now that I'm dealing with. So if I meander in this introduction, I'm apologizing now. This is my fifth attempt at recording this introduction. But I do know this, I'm looking out the window of my hotel room across this beautiful panoramic view of this amazing city, out across the eastern ridge of the Mediterranean Sea, looking out towards Cyprus. And this is really an amazing place, an amazing place in a very topsy-turvy, politically and religiously conflicted part of the world. And I'm here to run the marathon tomorrow on Sunday. Why go all the way to Beirut to run a marathon, Rich? What are you doing?

• 3:52Rich Roll?

  Here's the story. I came here about two years ago to give a talk, to give a keynote, and I met some really amazing people. I toured the cosmopolitan and fashionable city center. I got primed on the strife, the challenges, the conflicts, the corrupted and rudderless political situation here, the economic stagnation.

• 4:12Rich Roll?

  I visited the mosques that stand shoulder to shoulder with cathedrals adjacent to these incredible ancient Roman ruins. I went cycling in the mountains outside of Beirut with Lebanon's premier adventure athlete, this guy Maxime Chaya, who's really just a great guy, through these amazing Cyprus forests that are Lebanon's hallmark. It really felt like I was cycling in Tuscany. It was just so beautiful. And I fell in love with this city, with this country, with its people, and its plight, and most importantly perhaps, its hope. And through that experience, I was connected with this woman named May Al-Khaleel. She founded Beirut's very first marathon 13 years ago, and she's gone on to grow it

• 4:55Rich Roll?

  into the biggest running event in the Middle East. And it's something that stands as a powerful force of peace in contradiction to the strife and the hardship that is part of daily life here. It's really an incredible and inspiring story. May herself was an avid marathon runner until she was hit by a car. It was a devastating accident that left her in a coma, teetering on death. She was hospitalized for two years, underwent over 30 surgeries. And as she convalesced in her hospital room, realizing that she would likely never run again, she decided that she wanted to find a way to give her city the gift of running that had given her so much. And the idea of creating a marathon was born.

• 5:37Rich Roll?

  And juxtaposed against Beirut's, at this point, kind of worn moniker as the Paris of the Middle East, there exists hundreds, actually thousands of years of tragedy here. In recent decades, there is, of course, the long-running civil war that went on from 1975 to 1990. In 2005, their prime minister was assassinated. Of course, you've got the Israeli-Lebanon conflict that came to a head in 2006. And through 2009, there's just been a lot of instability here. The parliament resigned. The country was at a standstill. They had no prime minister or president for a year. And you've got Syria really close, just to the north and the west. They've got about a million refugees who are piling into Lebanon right now. Israel, Palestine, and Jordan to the south.

• 6:22Rich Roll?

  And we're really not all that far from Iraq. It's a fragmented and unstable government that's rife with corruption.

• 6:30Rich Roll?

  There's a big public outcry right now about the garbage service with protests going on. And the marathon was really born out of this desire to create an antidote to all the political and religious strife and sectarianism. And it was a bold act on May's part because she was basically asking people at odds with each other, people who want to fight and actually kill each other, to run arm in arm in harmony. But it worked, and it's grown. And it stands as this really powerful example of the inherent force of running to heal, to be this instrument of peace and good.

• 7:12Rich Roll?

  It's really a true example of how running can change the world. And May gave an incredible TED Talk about her experience at the Big TED Conference a couple of years ago. That video has well over 5 million views. I was very moved by it. I'll link to it in the show notes, so you guys could check it out. You definitely should watch it. And when she reached out to me personally and asked me to come and participate in the marathon, I really just jumped at the chance to partake in what, at its core, is really a peace initiative and to document it. I'm making a little video on the whole experience that I'm going to be compiling and sharing in the weeks subsequent to my return home. So, that's the story. Changing topics to today's show.

• 7:57Rich Roll?

  By the way, I'm going to be sharing more about this experience later in later podcasts, but that's basically the nutshell of what's going on here. But today's show, changing topics. I've got my friend Robyn Chutkan, M.D., on the show, herself an avid marathon runner, as well as a snowboarder and a yogi. And Robyn specializes in gastroenterology. She's a medical expert on the very hot and of-the-moment topic of the microbiome and the inextricable impact the quality of our gut ecology has on everything, from overall health to disease to cravings. To put it in context a bit... Our bodies are made up of about 10 trillion cells, but our microbiome, all the bacteria,

• 8:38Rich Roll?

  viruses, and fungi that live in or on our bodies, number in the 100 trillion range. So in some sense, it can be said that we are 10 times more microorganism than we are human, which is kind of a mind blower, right? Most of these microorganisms are symbiotic, and maintaining a healthy culture of the right microorganisms is absolutely crucial to good health. And so, we're going to delve deep into the nuts and bolts of this fascinating and quickly evolving field of study in medicine. But first...

• 9:16Rich Roll?

  All right, on to today's show. Dr. Robin Chutkan is a graduate of Yale and received her medical degree from Columbia College of Physicians and Surgeons in New York, where she also did her internship and residency and served as chief resident. She completed her fellowship in gastroenterology at Mount Sinai Hospital in New York, and she is the author of the bestselling books Gut Bliss and, most recently, The Microbiome Solution, which is a really great, informative read. I highly suggest everybody check it out. Dr. Chutkan has been on the faculty at Georgetown University Hospital since 1997. In 2004, she founded the Digestive Center for Women, which is an integrative gastroenterology

• 9:57Rich Roll?

  practice that incorporates nutritional optimization, exercise physiology biofeedback, and stress reduction as part of the therapeutic approach to digestive disorders. She's authored dozens of journal articles and book chapters, and has been a featured lecturer throughout the United States and Europe. She is a medical consultant and on-air talent for the Discover Health Channel. She's a member of the Medical Advisory Board for the Dr. Oz Show, where she's appeared as a regular guest and has also made... National appearances on The Today Show, The Morning Show, and The Doctors. She is frequently interviewed as a medical expert for The Washington Post and Women's Health magazines, and has been consistently named one of the area's best doctors by Washington

• 10:36Rich Roll?

  Magazine. So, I've known Robyn for a couple of years. She is whip smart, she is delightful, and she has an incredible facility for communicating her knowledge and experience and perspective on the microbiome in a way that is very relatable and easily understood by the layperson. She's really great. When I was in Washington DC, I had the opportunity to go over to her house, meet her family, and go up to her study where she writes her books, and do this podcast. Plus, her husband is some kind of badass for the NSA. It's unclear exactly what he does. He won't say, she won't say. But the point is, I would not mess with him or her.

• 11:18Rich Roll?

  This is an absolutely fascinating conversation on all facets of gut and skin health that just might change how you live, how you shop for consumer products, how you bathe or don't bathe, and how you eat. Dr. Chutkan's motto is "Live dirty, eat clean." So, let's find out why.

• 11:42Rich Roll?

  Hey, Robyn.

• 11:43Robynne Chutkan?

  Hi, Rich.

• 11:43Rich Roll?

  How's it going?

• 11:44Robynne Chutkan?

  It's great.

• 11:45Rich Roll?

  Thanks for taking the time to talk to me today. I'm glad we could make it happen. We tried to make it happen at the Revitalize Conference, but I always go to these conferences, and I think, there are all these amazing people, and I'm like, I bring my podcast gear, and I'm gonna get, I'm gonna get all these people, and then there's just no time because everyone's busy doing other things. So, now we're in Washington DC, and I'm up in your cozy writing space office. Is this where the books happen?

• 12:10Robynne Chutkan?

  This is where I come when I have serious work to do. Most of the writing happens downstairs on the couch, but when I really have to bring it, I come up here. But thanks for coming in the middle of a hurricane, by the way, to Washington. This is great timing.

• 12:23Rich Roll?

  Well, the hurricane kind of petered out, didn't it? It's that thing with weather, you know, like, we were looking at the weather before we flew out, and it looked very dire, and I'm like, "Trust me, this is like, a lot of fear mongering. It's gonna, it might be windy and rainy, and that's gonna be just about it." And that's exactly what happened.

• 12:40Robynne Chutkan?

  True.

• 12:40Rich Roll?

  So, it's not that big of a deal. But, pleasure to see you, as always.

• 12:43Robynne Chutkan?

  Thank you.

• 12:44Rich Roll?

  We just completed a non-recorded podcast.

• 12:48Rich Roll?

  So now we're finally on the air and I'm so excited to get into all of this, all of this good stuff. I mean, certainly, I think it's fair to say that the microbiome is quite the zeitgeist topic these days, but you've been in this for quite a while. So it's a cool convergence of something that has been your field of study and expertise and specialty for a long time, kind of converging with mainstream fascination, right?

• 13:17Robynne Chutkan?

  Absolutely.

• 13:17Rich Roll?

  It must be, must be really cool for you.

• 13:19Robynne Chutkan?

  It is. It's really terrific to sort of feel like people are finally getting this, that this is important and what we've been jumping up and down and talking about for all these years, people are getting it. People are throwing away the hand sanitizer and refusing antibiotics unless they really need them and it's all good stuff.

• 13:34Rich Roll?

  How dare you with this radical proposition of yours.

• 13:37Robynne Chutkan?

  It's so revolutionary.

• 13:38Rich Roll?

  I know. Well, let's, let's like, let's back it up and just kind of, you know, walk through it step by step. So probably the first thing we should do is define what the microbiome is.

• 13:47Robynne Chutkan?

  So it's basically the trillions of bacteria that live in and on our bodies. Mostly bacteria, but also viruses and protozoa and helminths, worms, for those of us who have them. So about 100 trillion in all.

• 14:01Rich Roll?

  100 trillion. And how many human cells are we?

• 14:04Robynne Chutkan?

  We are outnumbered 10 to 1.

• 14:05Rich Roll?

  10 to 1, right.

• 14:06Robynne Chutkan?

  By our microbial cells and genes.

• 14:09Rich Roll?

  So it's this crazy thing where we're really just hosts to something that outnumbers us 10 to 1. It's crazy when you start to think of it that way. And there's this idea that, that when we talk about the microbiome, we're really talking about the gut bacteria, but, but really it applies to everything that's on our skin and our hair, like, you know, our biggest organ, obviously, our skin, right?

• 14:32Robynne Chutkan?

  And the ecosystem's really very tremendously. So even on your skin, the bacteria that live in your nasolabial folds, close to the nose and mouth, are completely different to the bacteria that live on your cheekbones, a couple inches away, on the same part of your face. So it is, you know, there, the microbes from the gut to the vaginal milieu, to the lungs, to the mouth, to, again, just a couple inches away on the skin are all completely different, based on the differences in moisture and oxygen content and sweat glands and all sorts of things. So pretty fascinating, the different landscapes.

• 15:09Rich Roll?

  And really, the idea is that most of these microorganisms are not foe. They're a friend, or they're, or they're kind of like neutral, right?

• 15:17Robynne Chutkan?

  Yes, exactly.

• 15:18Rich Roll?

  And, and how did you first become interested in this?

• 15:22Robynne Chutkan?

  So my area of expertise or interest is inflammatory bowel disease, Crohn's disease and ulcerative colitis. And those diseases, Crohn's, which is sort of the prototypical inflammatory bowel disease, was described by doctors Crohn, Oppenheimer and Ginsberg in the 1930s at Mount Sinai Hospital where I did my GI training. And we still, you know, almost 100 years later, just a little short of 100 years later, we're not really that much closer to figuring out what caused these diseases. Like most autoimmune diseases, the medical community, it's sort of like, well, you just have them. There's a genetic predisposition, but they're not really genetic diseases. So I was seeing a lot of these patients and I, like a lot of other people in this area, started noticing that many of them had this common thread of frequent antibiotic use.

• 16:07Robynne Chutkan?

  So I started asking and people would say, yeah, well, I was on a bunch of antibiotics for strep throat, but that was decades ago, or I took tetracycline for acne in my teens, but what does that have to do with me having colitis now or Crohn's now in my 30s? And then there was an article, a meta-analysis, look at a compilation of many different studies from Mount Sinai that came out and actually showed that antibiotic use, interestingly, the two antibiotics that we use to treat these diseases were main risk factors for developing them. So I, I just started to have this really uncomfortable feeling like, you know, we're, we're creating disease and not realizing it. And we really have to let people know. I would see patients coming in and they'd tell me they've been on antibiotics for acne

• 16:51Robynne Chutkan?

  for three or four years and lo and behold, now they were developing GI symptoms. And there didn't seem to be a really clear connection between those things in the minds of the people who were experiencing it and certainly not in the minds of the doctors who were prescribing. And I'd been that one of those doctors up until very recently. So I, I felt this very strong

• 17:13Robynne Chutkan?

  urge to spread the word a little bit. And unlike my first book Gutless, which probably 90% of the stuff in the book I knew and was just my daily experience seeing patients with GI problems and very little research, the microbiome solution was sort of the opposite. I learned so much writing this book. I had this basic idea that we were on the wrong path, that we, again, were thinking of our microbes as foes rather than friends. But I had no idea how much of the wrong path we were on until I really started researching it.

• 17:43Rich Roll?

  Interesting. So the process of writing the book was an edification for you in your own practice?

• 17:48Robynne Chutkan?

  Absolutely.

• 17:49Rich Roll?

  I like that. Cool. So, so let's explain maybe or explore a little bit about, you know, the function of the of a healthy microbiome and kind of what kind of biological functions it helps regulate and in terms of like keeping us healthy or leading us astray from health.

• 18:05Robynne Chutkan?

  So you talked about us being host to the microbes. If you think of our body as a factory and all these different things have to happen, the kidneys have to filter urine, the heart has to pump, the lungs have to swap carbon dioxide for oxygen, the digestive tract has to break down food into its constituent parts of protein and fat and carbohydrate and then absorb them through the lining and carry them to the different organs for energy. All that stuff has to be done by some things, someone. And those some things, someones are microbes. So they are sort of the worker bees for the factory that that help all these processes keep running smoothly, not just in the gut. Of course, that's where we, as you said, that's where the majority of the microbes are, but in all kinds of different

• 18:49Robynne Chutkan?

  areas, too. So if we think about something like energy for cells, energy for cells in our digestive tract, colonocytes, what do they use for energy? They use short chain fatty acids. Where do the short chain fatty acids come from? They're byproducts of the microbes, break them down and provide the short chain.

• 19:07Rich Roll?

  Glycogen.

• 19:07Robynne Chutkan?

  Yes, exactly. Producing vitamins. There are a whole bunch of essential vitamins that our bodies can't make on their own, that gut bacteria involved in methylation processes to create these vitamins. They clear toxins from our body, cancer-causing toxins, some less. Aggressive toxins. So there are all these vital functions. They turn genes on and off. That was something that was pretty new to.

• 19:30Rich Roll?

  Yeah, and I want to get into that, the whole like epigenetics aspect of this, which is pretty fascinating stuff. But I mean, really, you know, at its core, essentially what you're saying is you're sort of maintaining this healthy gut flora and, you know, microbial ecology that, you know, propagates all over your body is absolutely essential to to maximizing health and preventing disease, et cetera. But this is sort of at odds with kind of the last several decades of medicine and this kind of over sanitization of not only our environments, but our bodies, right? And with that, I would assume comes either an ignorance of the important functions of the microbiome

• 20:11Rich Roll?

  or just a sense of it not being essential or important. Is that fair to say?

• 20:16Robynne Chutkan?

  That's absolutely fair. So in the 1950s, a researcher from the London School of Tropical Medicine and Hygiene named David Strawn was tasked with trying to figure out why they were seeing so much eczema and hay fever, which are sort of classic autoimmune diseases in post-industrial London. Everybody had left the farm for the factory and they were seeing this sort of epidemic. And he found two really interesting, it was a 27 year study, looking at thousands of kids and their families. And he found two really interesting things. Number one, kids who lived in large households with lots of siblings had far fewer lower rates essentially of hay fever and eczema because they were sort of being immunized by their siblings

• 20:58Robynne Chutkan?

  who were sneezing on them, coughing on them, dirting them up in general, which we now know is a good thing. And children who came from more affluent households where there were higher standards of hygiene with bathing all the time, washing all the time, things were super clean, had also higher rates of these things. So it was good to be. It was good to be in a large litter, if you will, with lots of littermates. And it was not good to be too wealthy and too clean. And at that time, I'm not suggesting that people of higher socioeconomic status are cleaner in general. But that was a phenomenon in post-industrial London is that higher socioeconomic households of more means had more access to these sort of newer, at the time, hygienic modalities.

• 21:43Robynne Chutkan?

  They had more showers and baths and so on. So that was the beginning. That formed the foundation for something that's called the hygiene hypothesis, which basically says that our immune system needs exposure to germs, to bacteria, for training so that it can recognize and distinguish between friend and foe. And when that doesn't happen, as was what was happening in post-industrial London, when people were starting to be cleaner, is that the immune system gets confused. And then it starts to react to its own body. So in the case of the diseases I see, Crohn's and Eustav colitis, the body starts to react to the gut tissue and creates ulcers and inflammation.

• 22:21Rich Roll?

  Right, they're autoimmune diseases.

• 22:22Robynne Chutkan?

  Autoimmune. In the case of arthritis, it's a joint, psoriasis and eczema, it's a skin. So there's a direct correlation between autoimmune diseases and the level of hygiene and sanitation. As countries get more industrialized, more developed, and the level of sanitation and the use of things like hand sanitizers and antibiotics and so on, fluoride, chlorine in the water, as that increases, the rate of autoimmune diseases start to increase. And we're seeing this in India and the Middle East. And it's a real problem because, again, we have to figure out, I mean, it's great, chlorination of water helped to eradicate cholera outbreaks and so on. So it's sort of a tough situation. You don't want people drinking dirty water and coming down with outbreaks of cholera.

• 23:05Robynne Chutkan?

  But at the same time, with super sanitizer water, now it's full of chlorine and chemicals. And again, it's one of these contributors to autoimmune disease. So there is a balance there between being safe and not having large numbers of people exposed to potentially harmful microbes and just super sanitizing everything and creating diseases.

• 23:25Rich Roll?

  Right, yeah, it's like the... The pendulum has swung too far.

• 23:28Robynne Chutkan?

  Yes.

• 23:28Rich Roll?

  I mean, certainly, you want, you know, a sanitary situation in the event of like an acute, you know, infection, right? You want, you want like the surgery room.

• 23:37Robynne Chutkan?

  You want that clean.

• 23:38Rich Roll?

  You want the instruments to be, you know, very sanitary. But we've kind of taken that idea and run too far with it, right? Like the Purell, you know, our Purell culture is out of control. And, you know, the idea behind that is, is, oh, if you want to not get sick, you want a germ-free environment. But basically, it turns out it's the opposite. Like that kind of low-grade, continuous exposure to all sorts of, and maybe pathogens is too extreme a word, but just, you know, the general environment in which we live allows our immune system to respond in kind and kind of, you know, do its push-ups so that it's prepared for when the day comes when you have that kind of over-exposure to something that might make you sick, so that your system can do what it needs to do.

• 24:23Robynne Chutkan?

  That was just, that's exactly right. There was just a fascinating article just a couple of weeks ago that was published where they found evidence of viruses in the newborn's microbiome. So we really get most of our microbes during the process of birth, ideally as we're passing through the birth canal, through the vaginal canal and swallowing a mouthful of microbes as we do it. C-section babies, as you know, have much higher rates of asthma, allergies, autoimmune diseases, obesity, because of missing out on that. That's actually, it's probably the most important moment in your life is when you're coming out through the birth canal and getting colonized. But there was just an article published that showed that in newborn babies, these were vaginal births primarily, there were evidence of all these different viruses.

• 25:07Robynne Chutkan?

  And again, we think of viruses as bad. And some of them were bacteriophages, which are viruses or organisms that eat bacteria. And these were healthy babies. So what they're realizing is that, what we're all realizing, is that even things like viruses that we think of as bad and, you know, get out the Purell are actually an essential part of a newborn's microbiome in training their burgeoning microbes, how to react to this stuff. And that if we start eradicating this, and this is sort of what we do when we don't understand, we don't know, we just eradicate it. Let's just kill all of them until we figure it out. And that's gotten us into some, some serious troubles. So the exposure to microbes is an essential part of having a balanced immune system. And most people who get sick,

• 25:51Robynne Chutkan?

  it's not because they're being exposed to some virulent virus or bacteria. You know, it's not because of coming to contact with somebody with Ebola. It's because they haven't been in contact with enough bacteria and viruses and so on to train their immune system. And I think we see examples of this all the time. I think we all know people who never get sick. And then we know the people who, you know, it's sinus infection after sinus infection. And usually the people who never get sick are eating a lot of plants and they're not using a lot of hand sanitizer and they're not using a lot of antibiotics. And that's not an accident.

• 26:22Rich Roll?

  Yeah, cool. So if we track it through kind of like, you know, the lifespan of a, of a typical individual, starting at, you know, in utero. So coming through the vaginal canal, being born is extremely important. You get that like, you get, you get covered in all of these, you know, these, these microorganisms, you get a big gulp of it, I suppose, as you're born. And when you have a C-section, you're denied that kind of like rite of passage of being born that kind of coats you and stuff that you need to be as sort of base and elementary about it as possible, that will serve in kind of seeding your microbiome for, you know, better health as you mature.

• 27:00Robynne Chutkan?

  And Rich, you know, I went through medical school and good places. I was at Columbia for medical school residency, I trained at Mount Sinai. I had never heard this. I heard this for the first time at Center for Mind, Body, Medicine's Food as Medicine course, fantastic course. Huge shout out to Jim Gordon, who started that organization. I heard that for the first time at that course and I couldn't believe it. I mean, my jaw dropped. I was like, what? This is an important thing going through the vaginal canal? And I thought, how could, I mean, people, that's something that people are much more aware of now.

• 27:29Rich Roll?

  But I thought- What percentage of people get C-sections?

• 27:32Robynne Chutkan?

  It's now almost one in three in the US. And granted, some of those are necessary, breach births and the mothers in distress or the babies in distress, but the vast majority, the vast majority are done because of convenience. And people don't know, OB-GYNs don't know. When I talk to some of my OB-GYN colleagues about this, they- Look at me like I have two heads. They're like, what? So we, again, you know, most physicians and most people, one could argue, it's slowly changing, think that the cleaner you are, the better. And as you said, there's some good times to be clean. If you're having your leg amputated, you're having your appendix out or something, it's good to have a clean environment.

• 28:07Rich Roll?

  You don't want to rub dirt in the open wound.

• 28:09Robynne Chutkan?

  But actually, speaking of, speaking of rubbing dirt in the open wound, there is a fantastic way to rewild a baby who has been born by C-section. And that's just to take a little gauze swab and soak it. And obviously, it doesn't have to be sterile because we're soaking it in microbes and just sort of soak up the vaginal juices of the mother and then wipe the baby down with it after.

• 28:32Rich Roll?

  Interesting.

• 28:32Robynne Chutkan?

  To sort of, you know, to try and approximate passing through the vaginal canal. It's such a simple, low-tech way of doing it. But instead, what do we do? You know, we yank the babies out after C-section and then we sort of sterilize them. We wipe them down with all this bactericidal stuff. So we really have to rethink what it means to be human and to be healthy and our relationship with microbes. And, and this idea that the cleaner, the more sterile, the more chemicals we have in our environment, the healthier we are. If you go down that road, you will end up in a really bad place as far as your health is concerned.

• 29:10Rich Roll?

  Right, right, right. And there are actually like studies, right? Are the correlative studies that, that look at the incidence of illness as it relates to C-sections? Like, is that correct?

• 29:21Robynne Chutkan?

  Yes, absolutely. So, C-sections are a big risk, not just for babies born that way. As I said, increased risk for obesity, allergies, autoimmune disease, but also the risk to the mother. I mean, C-sections are surgery. So there is, you know, the risks go from more minor things like wound infections to death. And the medicalize of medicalization of birth in general. Now, I I'm a physician. I'm a conventionally trained physician with an open mind. And I am very happy that there are hospitals out there. I'm happy that there are neonatal ICUs and well-trained OB-GYNs for when we need them. But this is sort of the essential point for when we need them. And what we're seeing, not just with antibiotic use, but with medical care in general,

• 30:05Robynne Chutkan?

  that we're not using these resources judiciously. And there's a huge commerce factor here, right? I mean, you make a lot of money doing things a certain way. So when I was having my baby 10 years ago, my amazing daughter Sydney, I was kind of amazed. I mean, I had so many monitors going in and out. And I hadn't fully had my awakening then, so I somehow thought this was all great, that I had an intrauterine monitor threaded up to my uterus and an external monitor and an epidural in my back and an IV. And, you know, was just sort of lying on my back incapacitated by all of this. And not surprisingly, ended up with a C-section. But I thought this was great, that there was all this technology, you know, just in case.

• 30:45Robynne Chutkan?

  I was a completely healthy woman who arguably could have done this at home in the bathtub. Maybe I'm not advocating that either necessarily, but but it was it was a lot. And it actually was a big part of what inspired me to write the book, which is that I had the flu when I was giving birth and I had a high fever. My baby was fine, but the doctor said, well, just in case you have a fever, we're going to put her in the NICU. We're going to do a sepsis workup, which basically means you're going to look to make sure she doesn't have infection. That was all fine. They did a spinal tap. They drew blood cultures. They x-rayed her. But what they also did was gave her two very strong intravenous antibiotics just in case. And it's this just in case thing.

• 31:28Robynne Chutkan?

  And we're really stuck with having to figure out how to interpret that. I mean, I was a physician with, you know, a couple decades of experience. And I actually thought that was a good idea because when people say, well, your newborn baby, you had a fever, maybe she has an infection. Of course, all you think about is, you know, my baby's going to get Ebola. I'll like quickly treat her.

• 31:48Rich Roll?

  Prophylactically prescribing.

• 31:50Robynne Chutkan?

  Prophylactically prescribing.

• 31:52Rich Roll?

  Antibiotics.

• 31:52Robynne Chutkan?

  And now we know that the risk of doing that, particularly to a newborn where the microbes are just getting going, far outweighs in a situation like this, the benefits. And that really started her on this course of multiple antibiotics and the cycle of illness that continued till she was really a preschooler of air infections, pharyngitis, strep, every month. She, you know, her little microbes were just completely depleted. And I didn't realize that because again, I thought that illness equal antibiotic. And I didn't really have an understanding that most of these air infections, pharyngitis are viral and that they'll be self limited. But when your new baby is screaming and has a temperature of, you know, 102 at four in the morning.

• 32:34Rich Roll?

  Yeah, you'll do anything.

• 32:35Robynne Chutkan?

  You want to do something.

• 32:36Rich Roll?

  Right, right.

• 32:37Robynne Chutkan?

  You believe that this is what you should do. So.

• 32:40Rich Roll?

  And that young age is very precious in terms of kind of how the microbiome starts to sort of seed itself, right?

• 32:48Robynne Chutkan?

  It's a crucial time. I mean, by about age three, which is still really young, but by about age three, the child's microbiome starts to look very much like the adult microbiome and not surprisingly like the mother, because that's where a lot of the microbes come from, but like other members in the household. So giving antibiotics to newborns and to young babies. And now in my field in gastroenterology, we're seeing this unfortunate trend of babies, infants, being treated for reflux with acid suppressing drugs, powerful drugs that block all the acid and create a nice alkaline environment for the wrong kind of bacteria to grow. And there's some very simple alternative ways to treat that. Just having your baby, holding your baby upright after you fed them, ideally after you've breastfed them. Because all it is, is really spitting up.

• 33:33Robynne Chutkan?

  It's not this dangerous thing, but it's hard to hold your baby upright for half an hour. You might be feeding them four or five times a day. But again, you know, we have to sort of reevaluate things and sometimes decline this quick fix solution and really consider the ripple effect of something like that.

• 33:50Rich Roll?

  Right. In terms of, you know, Quick fix solutions. I mean, that applies to breast milk versus versus formula as well, right? Like, there's got to be all kinds of cultures of microorganisms in the breast milk that are important for the baby.

• 34:05Robynne Chutkan?

  One in particular called HMOs, human monogoligosaccharides, which are the third most common ingredient in breast milk, but completely indigestible by the baby because they're not there to feed the baby. They're there to feed the baby's bacteria. They're there to feed the baby's bifidobacteria. So if you're not breastfeeding your baby and you're giving them giving them soy formula, which is equivalent of about five birth control pills a day, or some other sort of, you know, manufactured formula, you're not getting the HMOs and numerous other ingredients that we probably don't even know about that are there to feed the microbes to really encourage the growth of the microbiome. So it's, you know, again, it's great that formula is there for those instances where mothers

• 34:47Robynne Chutkan?

  and milk goes south and there really, there is nothing. But encouraging that or suggesting that that is an equivalent option to breastfeeding just implies, I think, a real lack of understanding about the importance of this stuff.

• 35:01Rich Roll?

  Right, right, right. And then as we, as we sort of navigate through life, we're in, we're, you know, we're back to the Purell and we're lysol, spraying lysol over everything. We're eating the standard American diet. We're eating, you know, foods that are laced with hormones and antibiotics and we're drinking water out of the tap that has whatever it has in it. And all of these things, all of these environmental factors, including the soaps that we're using and the cleaning products and the shampoos and all of that, all of these things have a tremendous impact on the quality and the nature of our microbiome. So can you kind of like elaborate on that a little bit?

• 35:37Robynne Chutkan?

  Well, you, I think that was it. That was all beautifully summed up, Rich. I'm done. You said it all. I mean, that's, that's exactly it. It is not, this idea of sort of live dirty, eat clean is not, obviously judicious use of antibiotics is really high on the list, but it's really examining our relationship to nature, which is our relationship to our microbes. When I was researching this book and writing it, I started reading some of these sort of environmental ecology books. One in particular, Feral is a great one by George Mombio. And that one is about rewilding the planet, the oceans and the human body. And I saw so many parallels between what was happening inside our bodies and what was happening externally in the environment. So

• 36:19Robynne Chutkan?

  Our microbiome today has about two thirds of the species of somebody who's been living in the Amazon, or the Hazda in Tanzania, somebody who's been living in more sort of indigenous lifestyle. So we're missing about a third of our microbes, and they're probably not coming back. That's the bad news.

• 36:34Rich Roll?

  Right, from the get go. That's the amazing thing when I was reading your book is realizing that with each successive generation, because of the way that we live in our modern lives, we're killing these strains that are never coming back. So each successive generation is more depleted than the one that preceded it. So that people that existed, you know, even in New York City, you know, 100 years ago, had a much different kind of microbiome that immunized them, or maintained their health in a different way than what we have now.

• 37:03Robynne Chutkan?

  And the same parallels for externally. So we're in the midst of the largest species die-off since the dinosaurs disappeared. We're seeing 1,000 species a year. I mean, it's really accelerated. So there's so many parallels between what we're doing externally in our environment, the landscape, and what's happening internally. It really struck me because I had never thought of those things as really being related. So if you think of the earth as being the host, and we're the microbes on the earth, and then we're the host, and then we have the microbes inside us, and who knows, our microbes maybe have microbes inside them. It probably goes deeper. So it's really...

• 37:38Rich Roll?

  We could get into like particle physics here.

• 37:40Robynne Chutkan?

  Where did we come from? So we really have to, again, rethink our relationship. And it has to include our relationship with our environment, because those things are all related, you know. So simple things like opening a window, getting a dog. You met Hugo, Hurricane Hugo downstairs. I was asking Rich for some tips to make the dog behave. It's, we really, I have to, I have to, full disclosure, my daughter's an only child, and she's, she's a lonely only, so she'd wanted a sibling for a long time. She finally gave up on that. So then she hatched on the idea of a dog. And when she was around four, she was really making a full court press for a dog. So I said, okay, when you're eight, because of course, you've

• 38:23Robynne Chutkan?

  never turned eight, that was a million years in the future. And then she turned eight. And so I said, well, you're still too young when you're 10. She turned 10 this spring, and the dog was born on her birthday. So couldn't ignore that. And so we finally relented. But really, the research that I did for the book that showed that households with dogs, the kids have fewer infections, they take fewer antibiotics, that was pretty compelling evidence. And also...

• 38:49Robynne Chutkan?

  You know, my, I tend to be a little bit type A and you know, something spills, I want to wipe it up. Definitely not with any hand sanitizer, but you know, I like order, except in my writing spaces, rich as seen up here, which is a mess.

• 39:01Rich Roll?

  It's pretty neat. I think it's pretty neat up here.

• 39:03Robynne Chutkan?

  But I, I really realized that the dog was a paradigm for my own journey of rewilding and my child. And so within a couple of weeks of the dog coming, I found myself sitting in, you know, a clean white night gown and a white leather chair with a very dirty dog in my lap. And it was okay. And it was not just okay, it was actually good. I realized that this, that I needed more dirt in my life in a very real way, too. And so it was a little bit for selfish reasons that we got Hugo, but he's, uh, he's been amazing. If he would only stop chewing up everything and waking up at 5:30 in the morning.

• 39:43Rich Roll?

  Yeah, but he's rewilding himself. You know what I mean? That's who, that's who he is.

• 39:47Robynne Chutkan?

  And maybe, you know, he's making us wake up as the sun rises too. So there's all of that. That's good for us. But it really is, you know, looking at these simple things. So could you get a filter for your water so that you're drinking water with less chlorine in it? Can you open the windows most of the year instead of using air conditioner or heat? Could you plant a garden or even have something growing by the sink that you put your hands into and have contact with those amazing soil microbes? Could you get a dog or bed down to pet somebody else's and hopefully not get bitten in the neighborhood? Could you just have a less, uh, a less complicated relationship, I think with nature where it's

• 40:30Robynne Chutkan?

  actually in your life, where you're touching it, you're eating real food grown by maybe your hand, someone you know, a farmer, there's dirt on it, where things are just not as sterile. There's a, there's a place for sterility, but not in our everyday lives, the way it has crept in.

• 40:44Rich Roll?

  Right, right, right. Yeah, and this is all what you call rewilding and part of this program of eating clean but living dirty, right?

• 40:53Robynne Chutkan?

  Yes.

• 40:53Rich Roll?

  And I want to get into the specifics of that, but before I, before we kind of move, move on to that, I want to kind of camp out a little bit in all of these, the proliferation of all of these diseases that we're seeing that, you know, when you and I were kids, like, it didn't seem like that many people had these things. And now everywhere you look, whether it's these autoimmune diseases like ulcerative colitis and irritable bowel syndrome, all these digestive disorders, gluten sensitivity, celiac disorders. I mean, what else are, are you seeing? And, and kind of like, walk, you know, the average person through how this connects to the microbiome?

• 41:31Robynne Chutkan?

  So it really connects to this idea of the hygiene hypothesis. And if we look at, we, I, I talk about these diseases in the book as modern plagues, because you can superimpose the curve at which we've seen this, you know, incredible emergence of these diseases and, and high prevalence. You can superimpose that curve with the advent of antibiotics and really the overuse of antibiotics, more importantly. And those aren't the only factors. There are lots of other things. You mentioned some of them earlier, is the food we're eating and, and other ways that were sort of chemicalized unnecessarily. But certainly there is a clear connection. And the connection has to do, again, with the lack of training of the immune system, is that we're not, that these

• 42:15Robynne Chutkan?

  microbes are really essential. And when we don't have them, our immune system goes haywire. And so there are almost 100 different autoimmune diseases, and they affect about 50 million Americans. So if you don't have one, chances are you know somebody who does. And there is a very clear correlation. And again, if you look at a map of the world, you see that these diseases are almost non-existent in developing countries. And as they become more developed, more industrialized, more super sanitized, we start to see high rates.

• 42:44Rich Roll?

  That's the amazing thing.

• 42:45Robynne Chutkan?

  High rates of these diseases. So we train a lot of international gastroenterologists at Georgetown, where I'm on faculty, and I've been there about 17 years and the first or second year I was there, so about 15 years ago, we trained a fantastic gastroenterologist who went back to Saudi Arabia where he'd done his medical training. And when he was here with us, he was fascinated by Crohn's disease. He said, "We don't have any Crohn's disease in Saudi Arabia." Now they have a clinic devoted just to that. So, development and affluence can sometimes have a price. And I'm all for development. I mean, I'm all for not drinking dirty water.

• 43:20Rich Roll?

  Kentucky Fried Chickens and Carl's Juniors aren't helping that either. Yeah, I have a friend who, while I was in, I did a couple of talks in Saudi Arabia last year, and yeah, they're seeing all these things for the first time there. And they're ill-equipped to deal with it because it's the first generation of having to deal with obesity and diabetes, lifestyle disease and all the, and the like, you know? And it's a direct result of, of, you know, development and adoption of our kind of lifestyle habits.

• 43:48Robynne Chutkan?

  And access to things can sometimes be a status symbol as communities become wealthier. So, for example, the US still has the highest per capita use of antibiotics, but India has the largest use of antibiotics in the world. And as people become more successful and wealthier and can get access to medical care and antibiotics, they, again, that sort of has this positive association, like, it's great that I can go to the doctor and I can get antibiotics whenever I want. So, you have to also overcome that idea and try to explain to people that, you know, we're not trying to push you back into poverty, but that over-medication is a real problem because people see it as a sign of progress. People

• 44:29Robynne Chutkan?

  see having medicine, which can be life-saving, as we all know, as a really good thing. And of course, it can be, but it can be a really detrimental thing, too.

• 44:38Rich Roll?

  Isn't it also kind of a function of our over-litigious society? Like, all these doctors, they don't want to get sued. It's just easier to say, "Well, I prescribed this thing," you know what I mean? So, they can say that they did that and they kind of cover their ass that way.

• 44:51Robynne Chutkan?

  Well, I think we really need to have some litigation the other way. I think that when there's a class-action lawsuit against dermatologists saying, you know, "You put my child on tetracycline for..." Three years and now they have Crohn's.

• 45:03Rich Roll?

  Kids are on it. Teenagers are on that stuff for years.

• 45:05Robynne Chutkan?

  Yeah, that's when we'll.

• 45:06Rich Roll?

  Like hydrogen bombs going off in their, in their gut.

• 45:09Robynne Chutkan?

  That's when we'll start to see it change. I mean, the astounding fact is that five days of a broad spectrum antibiotic, like the kind that is used to treat sinus infections, acne, so on, removes a third of your gut bacteria. So imagine what three years.

• 45:22Rich Roll?

  Spectrum is like, just to, to clarify, like a broad spectrum antibiotic is one that isn't specific to one strain. It kind of just carpet bombs all kinds of stuff that's going on in your gut. Yes. Is that correct?

• 45:34Robynne Chutkan?

  And so a broad spectrum antibiotic is great if somebody has sepsis, life threatening, overwhelming infection, and they're about to die in the intensive care unit. That's the time for a broad spectrum antibiotic. Acne, that's not the time for a broad spectrum antibiotic. And again, up until really a few years ago, one could make a convincing argument that well, dermatologists were sort of in the dark, as were gastroenterologists and internists and everybody else. But now we know, we're finding out. And so we have to find other solutions. Plus, irony is that we use antibiotics for cystic acne and things clear up eventually. But inevitably, people have to get put on another antibiotic, another antibiotic, because the bacteria become resistant and people end up, their skin ends up being worse.

• 46:15Robynne Chutkan?

  And then they end up with rosacea and they have red, inflamed, horrible skin because you have destroyed that delicate ecosystem, that balance between the Propriano Bacterium acnes and the staph on the skin and all the other, all the other essential organisms. You've totally messed that up and it's very difficult to restore that. So it's not even a good way to treat it. It's one thing if it were an incredibly effective way to treat it, but it had some side effects. It's a, it's a very short fix.

• 46:44Rich Roll?

  Right, right. Interesting. Yeah, I have a friend who suffers terribly from ulcerative colitis and has tried everything and he's had doctors wanting to remove his colon. And, you know, when it's inflamed, like he literally, you know, has to go to bed for like days at a time. He can't do anything. And he's convinced that it's directly related to, you know, batteries and batteries of, of, you know, antibiotics that he took as a kid. And he's seen all these specialists. He hasn't seen you. I'm telling him to get him to come out and see you. But, you know, he said that one of his specialists said his, his intestinal lining is so paper thin, like it doesn't, there's no microbiome in there. And even, you know, he's blasting

• 47:26Rich Roll?

  it with probiotics and still it's, he's having so much difficulty having it seed.

• 47:31Robynne Chutkan?

  You know, we have really terrific results with most people, but not with everyone. So we change people's diet. We put them on a plant-based diet. We take out a lot of the junk, the refined sugar, the dairy, the processed carbohydrates. But even so, not everybody gets better. We put them on a robust probiotic. There are even circumstances where some of our patients do stool transplants. You know, once you get over the yuck factor, it makes perfect sense.

• 47:54Rich Roll?

  Yeah, we're gonna talk about that.

• 47:55Robynne Chutkan?

  It's a super probiotic, but not everyone gets better. And it's, um, you know, as much as we have terrific results, it's so sort of disappointing and infuriating because, and I always start out by apologizing to patients when I see them. I said, I don't know you and I didn't give you antibiotics for 11 years, but a physician did. And I really apologize on behalf of the medical community for that because unquestionably, even though this issue of microbial health is a really optimistic message because we can't change our genes, but we can change our microbes and we can change them quickly. There are clearly instances where there is so much damage and that really relates to damage on a cellular level also, that it just cannot be restored. And that's heartbreaking. When

• 48:38Robynne Chutkan?

  I, when I see people, I had a patient who came from out of town and he had been put, he had been on 27 years of antibiotics for acne, which I just found unbelievable.

• 48:49Rich Roll?

  Whoa.

• 48:50Robynne Chutkan?

  Then he developed celiac disease, which, you know, people think that this whole gluten intolerance thing is such a fad. And he didn't just have gluten intolerance, he had a real celiac disease. But there are several studies from Scandinavia that show that antibiotic use en masse celiac disease. So people of European ancestry, one in four people of European descent have the genes for celiac disease. But what triggers the disease? One in four people of European descent certainly don't have celiac disease, but when you're genetically susceptible, what creates that environmental trigger, we're now finding out is antibiotic use. So frequent antibiotic use, which is why so many people who have dysbiosis, a term we use for altered gut bacteria, feel better on a gluten-free diet because

• 49:34Robynne Chutkan?

  they are gluten sensitive as a result of their antibiotic use. It's not a coincidence. So this lovely man had developed celiac disease and then the doctor said, oh, now we know what's wrong, why you're having terrible diarrhea. And he was having all kinds of other symptoms too, neurological symptoms, rashes. So they said, you just have to take out gluten and you're going to be restored. You're going to feel great. He took out gluten. He was as close to a hundred percent gluten free as you can get. And after three years, he still wasn't better. Most people respond within a few weeks or even a few months. He still wasn't better. And he did all these things. He jumped through all these hoops. He was on a grain free diet, but eating a lot of meat when we met him. And so we switched things around and got him to eat a lot more plants. He still wasn't better.

• 50:16Robynne Chutkan?

  He was amazing at following every bit of instruction we gave him. And he just did not get better. Some things got better. The gas, bloating, the diarrhea got better. But these odd neurological symptoms didn't. And he was looking into getting into a trial for stool transplant. But he didn't have a clear diagnosis. You know, he had sort of MS type symptoms, but not exactly. And it was just heartbreaking because had he known that this is where he would end up, he would never have taken those antibiotics. And I'm sure had the dermatologist known, she would never have prescribed them. So I think medicine is full of precedent of us being very well intentioned and ending up in a bad place.

• 50:59Robynne Chutkan?

  I'm a fan of this series called A London Hospital.

• 51:02Rich Roll?

  Yeah.

• 51:03Robynne Chutkan?

  Which is, it's set in the East End of London in 1906. And it is a historical sort of recounting of what was happening at this charity hospital in the East End of London in 1906. You can just imagine with tuberculosis and cholera, and there were no antibiotics. And I watch as a physician say with great authority, you know, bring on the leeches. Or they were using radiation to treat boils. And of course, the boils got better, but people died of cancer from the radiation. And we're still in the midst of this sort of body snatching, organ snatching way of dealing with things. So if your colon is inflamed, we should just take it out. And I, I myself have recommended that at times when people.

• 51:45Robynne Chutkan?

  Colon just wasn't getting better, but we realize that removing an organ, particularly when there's microbial imbalance, does not solve the problem. And unfortunately, we're seeing that. We see people who have their colons out for ulcerative colitis and are not just not better, sometimes worse. And we can't, we haven't completely figured out how to undo those sometimes decades of antibiotic use in those people and how to really restore the microbiome. But it's a great show to watch because you'll see that 108 years later, we're still stumbling around in the darkness for the most part.

• 52:18Rich Roll?

  Yeah, I want to check out that show. It reminds me, and I was going to bring this up, of this other show called The Nick. Have you watched The Nick?

• 52:25Robynne Chutkan?

  I have. It's very similar.

• 52:27Rich Roll?

  Yeah, it's, I mean, I just think that show is amazing, you know? And it's 1900, Clive Owen plays a surgeon, and they're really just at the beginning of trying to make, you know, these sort of discoveries about how the body works and how to, how to sort of perform surgical operations. And they grapple with how to do an appendicitis. And just episode after episode, they're killing people like crazy. And they're making all these ridiculous, you know, errors. Their, their, the X-ray machine gets invented and they're just standing in front of the X-ray for like hours at end, like, you know, getting radiated. And they're exposing people to mercury and like all kinds of crazy stuff. But it does, it makes you think like, well, what are we going to look back on and think, well, that was insane, right? So perhaps, you know, removing the colon or whatever else we're doing.

• 53:09Robynne Chutkan?

  C-sections, removing gallstone, removing gallbladders for gallstones rather than telling people to eat less cheese.

• 53:16Rich Roll?

  Right, right, right, right.

• 53:18Robynne Chutkan?

  Lots of precedent like that.

• 53:19Rich Roll?

  And then even like beyond, okay, so we've kind of explored, you know, the impact of, of the overuse of antibiotics. But it goes on from there, right? Like what I was really amazed by this exploration of the impact of eating animal products that are infused with hormones.

• 53:38Rich Roll?

  And antibiotics in their own right and the link between that and obesity. In other words, injecting these animals with antibiotics and hormones to get them to fatten up quickly and then we eat them and then that seeds in our microbiome and then we sort of take on that same kind of pattern, right? Like it makes us obese in the way that it makes the animal obese.

• 54:02Robynne Chutkan?

  So antibiotics have been used for animal fattening for decades, really since the 1950s, but much more aggressively now. And we know that giving animals antibiotics can increase their weight by as much as 15% very quickly, which is 15% more profit for an animal you're taking to slaughter. And this current statistic is that 80% of all the antibiotics sold in the US are used in the animal industry, which is pretty shocking.

• 54:29Rich Roll?

  Right, so even if you're not going to the doctor and you're just eating these products without, you know, right, you're taking antibiotics.

• 54:38Robynne Chutkan?

  You're getting it. And the paradigm of calorie in, calorie out, and for a long time, I think, I, like a lot of other physicians, thought, well, people come in and say they're, this is what they're eating, but they must be somehow lying. They must be eating a couple pints of Haagen-Dazs after bedtime and just not copping to it. And we really now know that the microbiome and obesity is different. So if you take microbes from an obese mouse and you transplant them to a germ-free lean mouse, they gain weight without any change in the diet.

• 55:09Rich Roll?

  Yes, crazy.

• 55:10Robynne Chutkan?

  Which is astounding. So microbes in this sort of obese microbiome profile are better at harvesting energy. They can pull more calories out of the same food. There are times when it's good to be able to harvest energy better, like if you're malnourished and food is scarce, but in our society where food is often plentiful, particularly the wrong kind, being better at harvesting energy is not a good thing. It leads to obesity. So we know that the microbiome is different and that, given the exact same food to eat,

• 55:42Robynne Chutkan?

  One set of people can gain weight and the other people not, based on these microbial differences. So it really is far more complicated than calories in, calories out. And it's also what you're eating. Are you eating things that are useful? Are you eating plant fiber? That can actually help to grow a good gut garden that provide the substrate for your bacteria to grow? Are you eating processed carbohydrates that raise insulin levels and get stored as fat and activate the wrong kind of bacteria? So that, that statistic there, I found was so fascinating, the series of experiments. They've also done those experiments for inducing anxiety. You can take microbes from an anxious or depressed mouse and transfer them to a germ-free, normal mouse and induce anxiety-type behavior, depressive-type behavior.

• 56:27Robynne Chutkan?

  And it's one of the things that patients will often remark on when we do this sort of microbiome rehab. We get them eating differently. We put them on a robust probiotic. We remove the antibiotics from their diet. Many, many times, people say, our patients with Crohn's and ulcerative colitis will say they're much less depressed. Now, it's hard to know if that's just healing a chronic illness. If you're not having 15 bloody bowel movements a day, that might be a reason why you're less depressed. But we definitely think there is a CNS effect. There is a neural effect on the brain, too, when the microbiome is changed. And we've seen it in some of these diseases, in MS and Parkinson's depression.

• 57:07Rich Roll?

  That's amazing. That's almost as wild as the connection between the microbiome and cravings, because this is where it gets super crazy, right?

• 57:17Robynne Chutkan?

  Yes.

• 57:17Rich Roll?

  So is this for real? Like,

• 57:19Robynne Chutkan?

  This is for real.

• 57:19Rich Roll?

  I've seen these studies where, you know, basically, I think they've done some studies with chocolate where they can show that, you know, the quality of the microbiome literally like hijacks in some respect, like the nervous system and the impulses to the brain that trigger these cravings. So when you think, I'm craving this food, it's really not you as a sentient human being. It's your microbiome saying, this is the food that I need in order for me to live. And the example that I always use, that I used it in Finding Ultra. Was, and you correct me if this is incorrect, if you think this is wrong, but that movie Super Size Me, and I've told this story before, Morgan Spurlock, you know, the first couple of days that he's eating McDonald's, like he's, like there's that scene where he throws

• 58:02Rich Roll?

  up out the window after he drinks a shake and he's disgusted by the whole thing. And then two weeks later, he wakes up and he feels sick. He almost feels hung over. And then he goes to McDonald's, eats breakfast, and he's like, I feel amazing, you know. So that, like what he, what was repelling him, suddenly he develops a craving for. And it seems to me that in that two week period, he's completely transformed his, his gut biome. And now like he's craving these, like his, his microbiome is triggering those impulses to crave those foods to keep that, that ecology alive.

• 58:35Robynne Chutkan?

  To keep them alive. What's crazy, Rich, is that the microbes can even change the taste buds, the palate, so that your taste for different, not just your craving. So you think of having an overabundance of yeast species and wanting more sugary, starchy stuff, but they can actually change your taste buds so that certain foods taste better in order to ensure their survival by you going out and getting that food. And I was listening to one of your podcasts the other night, and you were talking about when you became fully plant-based and how getting off cheese was like getting off OxyContin, how it was so hard. So we know that certain foods like chocolate and cheese trigger dopamine receptors, a pleasure centers in the brain. And it is, people will describe, it's a typical

• 59:19Robynne Chutkan?

  sort of addict cycle of you, you know, sort of a 24 hour cycle where you crave it and you try and, you try not to give in, but then you eventually succumb and you sort of devour it. And then you feel remorseful. And then there's this whole resolve that I'm not going to have it again. And then 24 hours later, repeat. And it is a classic addiction cycle. And it is not, I mean, it is so, you know, people feel so relieved when I tell them, like, listen, I believe that you have a lot of willpower. You know, I ran 20 miles this morning and you, you're very committed and dedicated and strong, but you feel like you don't have any control because you really don't.

• 1:00:00Robynne Chutkan?

  And what we've seen is that when people go on, for example, when people go on low carb diets and they cut out essentially most grains, if they're on some sort of strict low carb diet and they cut out the sugar and the processed carbohydrates, their cravings for that stuff go away pretty quickly. And we haven't really understood how that works. So there was a study from Harvard last year where they took nine volunteers. This study was really important because most of these food studies have, for example, compared a population in Burkina Faso with a population in Florence, Italy. And one could argue there are other things that are different in Burkina Faso and Florence, Italy besides the food. It's a completely different environment, but they took the same nine people

• 1:00:39Robynne Chutkan?

  and they put them on a typical sort of Atkins low carb diet of pork rinds and prosciutto and cheese. And they looked at the microbiome before, during and after. They had them on the diet for about five days and then they rested them. And then they put them on a plant-based diet, a typical sort of developing world plant-based diet, lentils, jasmine rice, tropical fruit for snack. They were having bananas and mangoes, tomatoes. And they found that the microbiome changed incredibly quickly, within about 30 hours. So they saw when they were on the meat diet, there was an incredible proliferation of biliphilia, bile-loving bacteria, which are needed to break down the animal products

• 1:01:22Robynne Chutkan?

  versus when they switched to the plant-based diet. But not just the bacteria, the genes that were turned on and off changed dramatically also, and this harkens back to what you mentioned earlier, this field of epigenetics, which is fascinating. So the genes that were activated turned on and off. And it may explain why even in identical twins who have the exact same genetic material, we don't see 100% concordance for a lot of diseases. We see one twin developing it and the other not in diseases that we think are genetic. Because again, it's this microbial trigger, it's this environmental trigger of the microbiome. And your microbiome explains how a lot of different diseases are manifest or not, regardless of whether you have the gene, but based on what is happening in your internal microbial

• 1:02:08Robynne Chutkan?

  Milieu. So the food stuff is really fascinating, but again, real cause for optimism, because we can't do anything about our genes.

• 1:02:16Rich Roll?

  Right.

• 1:02:16Robynne Chutkan?

  But we can change our microbes and we can apparently change them within about 30 hours.

• 1:02:20Rich Roll?

  Right. It's crazy. But it does bring up, I almost feel like you have to have a philosophical conversation about free will, because you know, if you think like, well, this is me and this is who I am and this is my, these are my preferences and this is, these are the foods that I like, that's all called into question, right? It's all, in many ways, it's a function of, of what that ecology in your gut looks like.

• 1:02:43Robynne Chutkan?

  It absolutely is. And in fact, apparently, the only taste that is innate that we were born with is a taste of a breast milk. Everything else is acquired. Another, another thing I did not learn in medical school.

• 1:02:54Rich Roll?

  Yeah, that's crazy.

• 1:02:56Robynne Chutkan?

  But it really, it's very interesting for me when you think about putting it in the, in the context of addiction and you think of people who are dependent on alcohol and other substances, how is their microbiome different? And again, if you think, are they, are they cultivating microbes that rely on the alcohol in some way to survive? Or are their population of microbes that are harmed by the alcohol or the metabolites of alcohol, like acetaldehyde, so depleted that that somehow sort of removes the break that would prevent them from drinking more? So we've not really looked at food addiction, alcohol addiction, drug addiction in this light before. And I'm, you know, it's, it's difficult

• 1:03:39Robynne Chutkan?

  because clearly there is free will involved in some of this stuff and there's situational stuff and different environmental forces, but it seems hard to ignore a potential role of our microbes. We know that it's definitely there with the food.

• 1:03:52Rich Roll?

  Yeah, yeah, yeah. I mean, there's, there's the whole, look, there's a lot of emotional and psychological issues that come into play, obviously, when you're talking about a true addiction. But in terms of trying to kind of, you know, salve somebody's, you know, turmoil and making that transition of getting off whatever they're trying to get off, it would seem that it would open up the door to all kinds of interesting protocols. Like you could use probiotics to shift the makeup of that microbiome to, you know, sort of like alleviate some of those cravings and make a transition to a healthier way of eating, kind of more accessible for people.

• 1:04:28Robynne Chutkan?

  There's another really fascinating study published this year looking at people with eating disorders and showing that they had very different microbes. And again, you know, which comes first? And the microbes different because they've been eating a very restricted diet? Or did they have a different microbial makeup that sort of led them down that road? So I think we're looking at a lot of diseases now. We're looking at autism and finding that the microbiome varies, not just in kids on the spectrum, but in their mothers. We're looking at Parkinson's, MS, heart disease, and not to oversell the microbiome and claim that, you know, your microbes are off and that's why everything's wrong with you. That's why you can't dance and whatever else.

• 1:05:04Rich Roll?

  Everything can be blamed on this.

• 1:05:07Robynne Chutkan?

  Everything can be fixed with fixing the microbiome. But I think it really is important to look, just as for years, we didn't look at the psychological aspects of disease, you know, we just looked at, well, your gut's inflamed. And we didn't look at what that meant in terms of, you know, your interaction with other people and libido and mood disorders and so on. And we broadened our context for disease to include the psychological ramifications and manifestations of disease. I think we have to broaden our definition now to include the microbial manifestations and ramifications.

• 1:05:37Rich Roll?

  So what goes on with you, you know, every fall and winter, when suddenly the call to arms, you know, comes across the transom that everybody must get a flu shot immediately?

• 1:05:46Robynne Chutkan?

  This is, I have, I have a very good friend in town who's a terrific internal medicine doctor, Dr. Eda Bergstrom, and she has a travel clinic and she harasses me every year. I I try to stay clear of the flu shot vaccine decisions and just say, you've got to, yeah, you've got to sort it out on your own. Because, you know, it's so just sort of politically charged. But I will say

• 1:06:12Rich Roll?

  It's very delicate. Choose your words carefully.

• 1:06:15Robynne Chutkan?

  That, again,

• 1:06:16Rich Roll?

  I won't ask you about the vaccines.

• 1:06:18Robynne Chutkan?

  The health of your microbiome, you are going to be much more immune to the flu. Now, I'm not saying whether you need to get a flu shot or not. You got to sort that one out on your own. But you are going to be much more resistant to getting the flu if you have a healthy microbiome, if you have not been taking antibiotics every time you sneeze, if you have been eating a healthy nutrient-rich, plant-based diet, high in indigestible plant fiber to feed your microbes, if you have not been super sanitizing yourself into oblivion. These are all things, if you have been getting sleep, these are all things that will help make you more immune. To the flu and you know, when we, if we order these, if we sort of put these things out on a piece of paper and try and decide what's more important, that's tricky, but

• 1:07:01Robynne Chutkan?

  a lot of these things are right up there with a flu shot, let me say that.

• 1:07:04Rich Roll?

  Yeah, yeah, yeah. All right. Well, yeah, I don't want to get you in trouble or anything like that. But I mean, to me, I don't, I mean, I never get a flu shot. Nobody in our family ever gets a flu shot and you know, we rarely ever get sick. And it seems to me just, you know, that by the time the flu strain, I mean, this nature is constantly adapting and changing, right? So they develop this strain of flu shot and they tell everybody to get it. But the amount of time that passes in between when that, you know, sort of inoculation is devised and administered, in that period of time, this, this strain of flu has already changed. Like, most of the time, you're, it's, it's no longer susceptible to being

• 1:07:46Rich Roll?

  treated by that vaccination, I would imagine. Like, I don't know, I'm not a doctor and I don't want to get you in trouble, but I think we need like, sort of, you know, there's a, there needs to be more rationality injected into this, rather than just knee jerk, everybody go get a shot because somebody says you should.

• 1:08:03Robynne Chutkan?

  And somebody's making trillions of dollars from it. There's a lot of money at stake.

• 1:08:07Rich Roll?

  Who's looking to gain from all of this?

• 1:08:09Robynne Chutkan?

  Well, there's this sort of McCarthyism thing happening in medicine right now.

• 1:08:12Rich Roll?

  And then you're a crazy person if you say, hold on a second.

• 1:08:14Robynne Chutkan?

  Well, this is terrifying. I mean, there is this whole McCarthyism in medicine now where, you know, if you, most people practicing medicine would argue that vaccines are a good thing and they help prevent disease. We've eradicated smallpox and polio and lots of other things. But I think most thoughtful physicians would also say that perhaps we're over vaccinated in some ways. But there's this whole movement to actually, to take away physicians licenses, medical licenses to practice, who question these things, like vaccination, flu shots and so on. And it's absolutely crazy. We're talking about really respected physicians, like Dr. Sayers is an incredible pediatrician who sort of dared to say, maybe we're overdoing

• 1:08:58Robynne Chutkan?

  this a little bit. We're not saying that we shouldn't vaccinate people at all. And you know, when we trace this stuff back, when we trace back the recent assault on Dr. Oz, I mean, it all goes back to a handful of companies who have a lot at stake here, who are making a lot of money from this stuff. When he challenged the whole issue of genetic modification and not saying that genetic modification was evil, but that perhaps we need more data and we need more information. There was a full on sort of campaign to discredit him. We're seeing that more and more. And it's created this whole air of, I think there are lots of conventionally trained physicians who do have questions about this stuff and think that it's not a great idea, but they're very scared. I mean, they're

• 1:09:41Robynne Chutkan?

  actually scared to talk to patients about this.

• 1:09:44Rich Roll?

  Yeah, that's wrong. We have to have an environment where it's okay to ask these questions and you're not going to get, you know, marginalized just for raising your hand and saying, let's take a look at this. And, you know, I don't want to get too far in the weeds on this stuff. But, you know, it wasn't that long ago where there was only a few vaccinations and the pharmaceutical companies would kind of do this as a public service. And now I think there's 97. There's the battery of vaccinations now is way beyond, you know, what it used to be. And there's a lot of money being made and there's some interesting discussions happening. I'm looking to, you know, find somebody to come on the podcast to talk about this intelligently. And I think it's important who I get in order to do that. There is a very interesting book that Robert Kennedy wrote, Jr., called Thimerosal that I would suggest everybody

• 1:10:27Robynne Chutkan?

  It's a great read.

• 1:10:28Rich Roll?

  And I saw him present on this book and it was very compelling. And I'll talk about that in a later edition of the podcast. But yeah, I think we need, we need freedom and kind of a wide expanse in order to comfortably address this in a rational, objective way without that, like, you know, you're a crazy person or whatever, just because, you know.

• 1:10:47Robynne Chutkan?

  You know, the quack list.

• 1:10:48Rich Roll?

  Yeah. And there's a, you know, there's a lot of money being spent to kind of create that kind of environment, you know. So anyway, we can move on.

• 1:10:55Robynne Chutkan?

  Well, just a last thought about that. You know, we talked about the hygiene hypothesis, but the other part of that is something called the old friends hypothesis, which was another British professor came up with. And so the hygiene hypothesis says we need exposure to microbes and dirt to train our immune system. The old friends hypothesis says that we need not just exposure to sort of modern dirt and, you know, the common cold nowadays, but to Old things like measles and and older viruses and things to train our immune system. And so there's a lot of debate there about whether, I mean, nobody's going to argue about vaccinating against smallpox, but whether some of these vaccines and and yes,

• 1:11:36Robynne Chutkan?

  measles can kill people for sure. But the question is whether with the over vaccination, we are eradicating some of these old friends, some of these diseases that are maybe an important part of training our immune system. And we're seeing more autoimmune diseases as a result. So I'm not an immunologist. I'm probably not the person to answer that question, but it's fascinating, fascinating connection.

• 1:12:07Rich Roll?

  All right. So so here we are. We're over sanitized. We're over antibiotic, whatever the word is for that. We're too clean and we're getting sick because of it. So Robin, what's the solution? How do we get off the dime here and start getting in a in a better direction? Like, I'm ready to go, you know, roll in the dirt.

• 1:12:26Robynne Chutkan?

  Well, I tell you, my, nobody loves the whole rewilding process more than my 10 year old, who we just had friends visiting from Miami. And when she was telling the other 10 year old, her 10 year old friend who was here that, yeah, we don't have to bathe tonight. Her eyes opened really wide, her friend. And then her mom came down to talk to me and was like, Well, what's this about? No bath? So I said, Sydney, no, we're rewilding, but you know, other people have to decide how comfortable they are with the rewilding. So we went for a little run in the park today with the dog and nobody was too dirty. I took a little tiny rinse, but my daughter chose to not not rinse off at all. And it's all good. So we're we're doing this experiment in our family, but we have to be a little

• 1:13:06Robynne Chutkan?

  bit careful how we rope our friends in because I think the mom was not so keen about this. But yeah, it is really, you know, it's not this, the rewilding is not this really complicated thing. It's really just, I would really recommend that people, one of the first places people look is in their household product cabinet.

• 1:13:26Rich Roll?

  Right. I mean, we can first like, kind of divide this into, you know, the food that we're eating, and we can have a discussion about that. And then kind of our household product, the environment in which we live and the products that we use.

• 1:13:37Robynne Chutkan?

  And then we can talk about our approach to illness, because I think that's part of it, too. So if we talk about the food, and I'm going to stay clear of the debate about, you know, should we be eating meat? Should we be not? There's a lot of personal things with ethics and the environment and all kinds of things that go into that. But I will say that there's no question that the number one food to eat to grow a good gut garden is plant fiber. And there can really be no debate about that. It's indigestible plant fiber, foods that are high in inulin. So things like onions and garlic and leeks and lentils and asparagus and artichokes, celery, all that stringy fiber that really, what we're really looking to do is have stuff left over by the time it gets into the colon

• 1:14:22Robynne Chutkan?

  to feed the microbes. So if you think about something like a carbohydrate or animal protein, that's broken down, absorbed through the gut lining and converted to energy for different parts of our body. The indigestible plant fiber isn't well broken down in the small intestine. So it continues onto the colon where it gets fermented by gut bacteria. And it helps to produce short chain fatty acids that the cells in the digestive tract use for energy. But it also provides a growth substrate. It's, those are what we call prebiotic foods. They provide the food to feed our gut bacteria. And the truth is that

• 1:14:57Rich Roll?

  Prebiotic.

• 1:14:58Robynne Chutkan?

  Prebiotic, yes, prebiotic as opposed to probiotic, which are actually live bacteria. So whatever side of the coin you're on in terms of you eat meat, you don't eat meat, you aspire to eat less meat, wherever you are, eat more plants if you want to improve your microbiome. That's a very basic advice. We see a lot of patients in our practice who have adopted a more paleo lifestyle and they've cut out dairy and they've cut out grains and They're not necessarily better in terms of their gut inflammation. When we add more plants in, most of them see really, really significant results. So, cutting out junk food and refined sugar and so on is great. But if you're basically left with bacon and eggs, you're not going to be able to feed your microbes.

• 1:15:43Robynne Chutkan?

  So, it's really important that you increase the plant fiber. I have a simple one, two, three rules. So, one vegetable at breakfast, two at lunch, three at dinner, adds up to six. But really thinking about it in terms of each meal. So, the morning is pretty easy for us. It's usually a smoothie with some spinach or kale in it, or it might be eggs with some spinach. Lunch, if you're having a salad, again, that's pretty easy. Most people's salad has at least two vegetables. Or, you know, you're doing a soup and it's a vegetable soup. And then dinner, the three might be a salad plus two other side vegetables. Yesterday, we had asparagus, string beans, and a salad. So, it's really important to think about that because it's so easy, particularly for people who are not completely plant-based.

• 1:16:26Robynne Chutkan?

  It is as, we are not a 100% plant-based household, although we eat lots of them. So, it's very easy. We have aspirations. You see, my whole shelf is lined with your books and Veganist and all kinds of things. We definitely aspire, but we're not quite there. So, it is easy to let the vegetables slide, particularly if there's still a lot of animal protein on the plate. And you really have to keep track of it because more than any, you know, parents say to me, well, what can I do to boost my kid's immune system? I have Crohn's and worried my kid is gonna have to have Crohn's. It's very, very simple. There's not a super pill, there's not a super test, eat more plants. And people don't believe it because it sounds so easy. And also because lots of people don't like plants. So, they're sort of like, where's the pill?

• 1:17:11Rich Roll?

  Yeah, well, they also want the super fancy sexy answer, like, I wanna get the fecal transplant. Or, I'm gonna, what's the one probiotic that I can get that'll allow me to eat whatever I want? But because I'm taking this probiotic, I can tell myself that I'm doing the right thing.

• 1:17:25Robynne Chutkan?

  It's really tough, I think, for some of the parents because the kid's palate, you know, we talked about the microbes sort of leading the charge. So, once your kid starts eating table food and there's a lot, you know, it's a lot of goldfish and birthday cake and pizza and things like that happening, what we somehow have decided is kids' food in America, the palate really changes. And then if you throw a couple antibiotics in the mix, that child really craves that stuff. And so I tell parents, I'm like, you really have to look at this as a little bit of a crisis. If your child is refusing to eat any vegetables, I mean, it's one thing for having mac and cheese from time to time, but if they really are not eating vegetables, you're creating illness in this process. And so, you know, do what you have to do. Threats and bribery worked

• 1:18:09Robynne Chutkan?

  really well with our child growing up.

• 1:18:11Rich Roll?

  It's for real. And but the thing is, like, when you start feeding them healthy food and they go through that period of like, telling you they don't like it or whatever, they're not gonna starve. They will eat it eventually. So just keep showing up with it.

• 1:18:23Robynne Chutkan?

  And the palate changes too.

• 1:18:25Rich Roll?

  Yeah. And then finally, they'll be like, they're into it. You know, it takes some time. I mean, that's, you know, you have to be patient and you have to be committed. And I'm not gonna tell people it's easy. But is there anything more important? Uh oh, do we have to stop? You coming on in?

• 1:18:43Robynne Chutkan?

  Actually, I was, my husband just walked in the door and I, full disclosure, I was not a good vegetable eater growing up. I ate tons of fruit. I grew up in Jamaica and I, we had mango trees and all kinds of citrus in the backyard, but I was not a good vegetable eater. My husband eats vegetable, he eats salad, breakfast, lunch and dinner. He eats salad and hummus for breakfast most mornings. He is a phenomenal vegetable eater. So it's really made all of us up our game.

• 1:19:11Rich Roll?

  And he's like, I mean, I just met him, but I have, he's a, he's not like a wimpy dude. This guy is like a alpha male, like, yeah, like, he's at the, he works for Homeland Security, like, chasing Al Qaeda, right?

• 1:19:24Robynne Chutkan?

  I don't really know, Rich. I'd have to kill you if I really let it all out.

• 1:19:27Rich Roll?

  So if he can eat vegetables, then for the dudes listening out there, it's gonna be all right.

• 1:19:33Robynne Chutkan?

  He has, my husband grew up in South Carolina and as we, as we approached 50, we're seeing so many of his friends being diagnosed with diabetes, heart disease, people dying. And his dad had a history of heart disease and died from a heart attack in his seventies. But I feel so reassured by my husband's lifestyle. He's out running the trails with a dog in the morning. He's eating salad and hummus for breakfast and making green smoothies. And I keep telling him, I'm not worried about your cholesterol. You're going to be fine because really the way he eats and lives. So it is, it's hard to sort of have that confidence. I have it because I know a little bit about the stuff being a physician. But it really, I mean, if you read a book like Joel Fuhrman's Eat

• 1:20:18Robynne Chutkan?

  to Live, and he really presents the data, or Caldwell Esselstyn's Prevent and Reverse Heart Disease, and they show you the studies, you know, they, they, and I can tell you, I've been in that operating room, when they pull that plaque out of the coronary arteries, that's not kale. That's straight up lard. You know, they're really, there is a point, even with this genetic predisposition, where you can really make a significant difference in your risk for disease through the diet. So that's real. That's not sort of fantastical thinking, wishful thinking. What I think is fantastical thinking, is that you can continue to eat a diet high in refined sugar, and animal fat, and take a pill, and think that you're protecting yourself from disease. I mean, that's magical thinking.

• 1:21:03Rich Roll?

  Or that you, as parents, can eat whatever you want, and tell your child that they have to eat their vegetables when you're not doing it, and expect that they're going to fall into line with that. Like, it starts at the top. Like, you gotta walk your walk, and live it yourself, and set the example for the children.

• 1:21:20Robynne Chutkan?

  Just why I always eat my chocolate very late at night, after my daughter isn't dead.

• 1:21:23Rich Roll?

  If you think Sydney doesn't know, she knows, I guarantee you. We'll ask her after this.

• 1:21:26Robynne Chutkan?

  She knows where it's, where it's stashed.

• 1:21:29Rich Roll?

  Right, right, right. All right. So, so, you know, beyond that, though, you know, there's room for talking about probiotics and fermented foods. And I want to get to the fecal transplants, because that stuff's awesome. But like, all right, fermented foods, like, that's a big, you know, that's a good way of getting your probiotics in. But also, like, in terms of just talking about it rationally, I mean, probiotics are not a panacea, right? Like, they're not going to solve the problem for you. And I think in your book, you kind of talk about how Yeah, it helps, but it's not like by taking these probiotics that will completely, you know, take over your gut and do the right thing.

• 1:22:08Robynne Chutkan?

  And this is the impression people have. People think, well, I took an antibiotic, but then I took a probiotic, so somehow I'm equal.

• 1:22:14Rich Roll?

  They balance out.

• 1:22:14Robynne Chutkan?

  The analogy I like to use, it's like taking a bathtub, filling it with water, and then draining it out completely, and then adding a cup of water and thinking, okay, my bathtub is full again. So there's no probiotic out there that can completely undo, reverse the damage done by an antibiotic. It can mitigate it a little bit, but it can't. You're not back to sort of ground zero, net neutral with the probiotic. What's even more important is what you're feeding the bacteria, because I can give you the most robust probiotic on the planet. We use a prescription-grade probiotic in our practice. It's 900 billion of some really good species. But if you're not feeding them the right food, most people are pretty shocked when I tell them the bacteria only hang around 20 to 30 minutes and they're

• 1:22:57Robynne Chutkan?

  dead. And you hope it's enough time for them to quickly reproduce, just have a quickie, and start to repopulate the gut and colonize. But we know it's really what you feed them. So if you don't have enough of this indigestible plant fiber around to help them to grow-

• 1:23:10Rich Roll?

  They just quickly perish.

• 1:23:12Robynne Chutkan?

  ... and reproduce, they're done. They just basically pass out in your stool. So it's all about repopulating the gut, and that is a really painstaking, sort of labor-intensive process, and it involves a lot of plants. There's no shortcut around that. There's no sort of microbiome hack where you still get to eat Cheetos and hot dogs and have a good gut garden. Well, people say to me all the time, well, you know, I have a neighbor, I have a friend, I have a cousin, I have a sibling who only eats Cheetos and hot dogs and is remarkably healthy. And we do see people, I mean, we know people who smoke four packs of cigarettes a day and lived 205 and never get lung cancer, but statistically speaking, that's unlikely. But it also depends on what the microbial damage has been. So if you're one of those unfortunate people, like many of us are, who was prescribed antibiotics

• 1:23:56Robynne Chutkan?

  for acne, or got one too many Z-Packs for sinus infections, your wiggle room for being able to tolerate a crummy diet is going to be a lot less than somebody who basically has a fairly intact microbiome. They might have been born vaginally. They were nursed for a long time. They got lots of breast milk. They had very few antibiotics. So they're able to withstand the assault of the standard American diet in a very different way from if you were born via C-section, you were fed formula, you ate the standard American diet growing up, you got lots of antibiotics. So there are all these different factors, even environmentally, you know, what the water was like where you lived.

• 1:24:33Rich Roll?

  There was a interesting article in The Atlantic, like a week or two ago, that was entitled, Why It Was Easier To Be Skinnier in the 80s. Did you see that?

• 1:24:43Robynne Chutkan?

  I did.

• 1:24:44Rich Roll?

  It was pretty interesting. And it all had to do with like the differentiation in the microbiome, like in that era versus now.

• 1:24:51Robynne Chutkan?

  And the amount of meat we're eating was one of the points, too.

• 1:24:54Rich Roll?

  Yeah. I mean, how, explain that quickly. So it's like now it's easier to get, I mean, the antibiotics in the, in the meat, right?

• 1:25:01Robynne Chutkan?

  Yes. The idea is that now we're getting food, the meat in particular, that has more antibiotics in it. So we're doing antibiotic fattening inadvertently without realizing it.

• 1:25:11Rich Roll?

  Yeah, we talked about that a minute ago. I'll put a link in the show notes up. It's a short article, but it's interesting. Yeah, yeah, yeah. All right. So, so we've talked about plant fiber. We talked about fermented foods. What are some of the fermented foods that you?

• 1:25:26Robynne Chutkan?

  So sauerkraut and kimchi are two of my favorites. And there's a great book, Jeff Cox's book, The Essential Book of Fermentation. I've got some of his recipes in my book, The Microbiome Solution, little promo there, adapted from his book. And he's, he's got some stuff in there that's maybe not as healthy, like how to make your cheese and wine and so on. But he's got some great, great pickle and sauerkraut recipes in there. So fermented foods are a twofer because you're getting the fiber from something like cabbage when you eat sauerkraut. But when you ferment it, which is basically just water and salt and letting it sit in a mason jar, then you're growing this huge population of lactobacillus in the cabbage. And so when you eat the sauerkraut, you're getting the fiber to feed your existing

• 1:26:08Robynne Chutkan?

  bacteria. And then you're bringing in new bacteria, new lactobacillus with the, with the sauerkraut. So it's a twofer.

• 1:26:15Rich Roll?

  Right, you're like turbocharging it.

• 1:26:16Robynne Chutkan?

  Yes.

• 1:26:17Rich Roll?

  Right. Alright, so I think we covered the e-clean part, but let's get in, the fun part is the live dirty part, right?

• 1:26:24Robynne Chutkan?

  This is the live dirty, I should bring my grubby girl up here.

• 1:26:27Rich Roll?

  Yeah, I know. Well, you know, it's funny, because we had some emails leading up to today, and you were like, "Wait, are we doing video, or is this just audio? Like, do I need to clean up?" I'm like, "You can't clean up, you're the live dirty person," you know, even if we were filming. So, I mean, what does that look like? Like, it gets into really doing an evaluation of the products that we buy to clean our bodies and our homes, and, you know, everything from the water we're drinking, to the shampoos and the soaps, and, you know, not being afraid of, you know, having a little sweat on our body and walking around. I mean, how dare you, Robyn? We're gonna go to work without taking a shower?

• 1:27:05Robynne Chutkan?

  How dare you, have a little Theo? Well, you know, you look at some of these products, and this really started for me after my daughter was born, and I would look at some of these classic baby products that everybody uses, and start reading the ingredients, and I was like, "What is this stuff?" I mean, stuff that I'm like, "I don't even know what this is." Stuff you can't pronounce, stuff that was clearly not edible, and everything you put on your skin gets absorbed inside. So, I have a pretty high standard, which is if it's not edible, I'm always suspicious of it. But I started looking at this stuff and thought, you know, there's just no way I can put this on my newborn's skin. My newborn, who was born via C-section, got all these antibiotics, and then it trickled down to what I was using myself, and there are a

• 1:27:47Robynne Chutkan?

  couple issues. Number one is that a lot of these products are antimicrobial, or, you know, there are different terms they use, bactericidal, antimicrobial, but they have

• 1:27:57Rich Roll?

  Right, and those are all supposedly good things.

• 1:27:59Robynne Chutkan?

  Which are turning out to be not so good. So, they have things in them, like Trichinol San and the hand sanitizers, that is not only an endocrine disruptor that can affect thyroid function and so on, but is really deadly to a lot of your healthy microbes. And as luck would have it, the good bacteria, of course, are much more fragile than the bad ones. So, I'll give you an example that I find fascinating. Antiperspirants, there are two kinds of bacteria in our underarms for most people, the two major ones. There's staph, and there's coronabacterium. And men tend to have more coronabacterium, because coronabacterium are lipophilic, meaning they are fat-loving, and men sweat because of testosterone levels have higher amounts of fat in it. So, men have a little more coronabacterium. And I'm not trying to say that you smell or anything, right?

• 1:28:42Rich Roll?

  You are.

• 1:28:43Robynne Chutkan?

  I'm just making this, this point. So when you use an antiperspirant, the antiperspirant tends to kill off the staph population because they're more fragile. So you get the corneobacterium actually overgrowing. And then instead of this nice balance between the not smelly staph and the smellier corneobacterium, now you have an imbalance and you have higher levels of corneobacterium. And so now you need more antiperspirant because you smell more. So that's an example of a sort of vicious cycle where you disrupt the ecosystem. And all of a sudden you find like, oh, now I really stink and I really need more antiperspirant.

• 1:29:19Rich Roll?

  So it's kind of like an analogy would be, you know, you use chapsticks for, for your dry lips, but then suddenly your lips are, you know, they're, they're basically dry unless you become dependent upon that.

• 1:29:29Robynne Chutkan?

  Yes, and we see that with hair products too. Like you start using all these shampoos and conditioners and then wow, my hair is really dry and I need more of this moisture conditioner. So when you think about it and just, you know, I'm not trying to advocate that we all go back to the cave. But when you think about it, just from a sort of sensible point of view, there is just like there's no formula in a can that can approximate what is in breast milk. There's no moisturizer or can condition or conditioner that can come close to the natural oils that your scalp produces for your particular type of hair that's pH balanced and all the rest. Now, this is not to say that you should never wash your hair, but overwashing it, you know, scrubbing away the natural oils and the natural microbial environment, and then trying to replace it with some chemical store bought version.

• 1:30:15Robynne Chutkan?

  So I advocate just a little bit of a rinse if you're grubby and, you know, you sweat a lot. You're out riding and running and swimming. So, you know, there are times when you need to rinse off, but this idea that you're doing a full chemical peel of your body every time with chemicals.

• 1:30:29Rich Roll?

  Right. I mean, somewhere along the line, we've been told that like we have to wash our hair every day. Like, well, that's just genius marketing on behalf of whoever, right? Johnson and Johnson or whoever came up with that idea.

• 1:30:39Robynne Chutkan?

  And shampoo and conditioner.

• 1:30:40Rich Roll?

  Yeah, and all these things, right? Yeah. And then you realize like, oh, we're, you know, we're, we just do all these things because we just kind of grew up with it without really ever thinking about it. And like, of course. Yeah, the sea bum or whatever it is in your hair follicles and you know, all these things that we kind of need that we've evolved over millions and millions of years. And now suddenly, you know, in 1972, it was decided that this was all bad and we need to wash it off every day. I've gone to just washing my hair like once a week and my oldest son, he now has dispensed with all shampoo and he uses baking soda and apple cider vinegar.

• 1:31:15Robynne Chutkan?

  I love it.

• 1:31:16Rich Roll?

  So that's my next step. I gotta try that. But that's, is that, that's kind of what you recommend.

• 1:31:20Robynne Chutkan?

  Yeah, the apple cider vinegar is great. My, my daughter thinks it smells horrible.

• 1:31:23Rich Roll?

  Drink it, you can put it in your hair, it like does everything.

• 1:31:26Robynne Chutkan?

  But it really, you really notice the difference in terms of the thickness of your hair and so on versus when you're stripping it all the time. But you know, if you look at women's sort of cosmetic personal care products, I mean, they really did a number on us. So you're supposed to use all this toner to remove the natural oil from your face, then you use a moisturizer to try and put it back.

• 1:31:44Rich Roll?

  Right.

• 1:31:45Robynne Chutkan?

  It, it makes no sense at all. It's like the way we bracket our day with caffeine to wake us up and then people taking sedatives at night to help them go to sleep. You know, so you just have to, again, it's part of this do it yourself medicine of just being more of a thinking advocate for your own health. And realizing when you're being marketed to as opposed to, you know, when something actually makes sense.

• 1:32:07Rich Roll?

  Right. I mean, do you have like a list of approved products or kind of DIY versions of all these products that we, that we do?

• 1:32:14Robynne Chutkan?

  I have a bunch of recipes. I have recipes in Gublis and also the microbiome solution for personal care, for household cleaning stuff. With lemon juice and a little bit of vinegar and various things to make a cleaning solution.

• 1:32:28Rich Roll?

  Like coconut oil for your skin.

• 1:32:29Robynne Chutkan?

  Coconut oil is amazing for hair and skin. And so I have a bunch of edible recipes, like using brown sugar, cornmeal, coconut oil.

• 1:32:38Rich Roll?

  But basically in terms of soaps, it's like if you can't eat, if it's not edible, like it's not a good idea, right? It's kind of your general rule.

• 1:32:44Robynne Chutkan?

  Well, I will say that I, I, the soap I use, I don't think I could eat, but it's still really mild. I mean, I probably could. I don't think anything bad would happen.

• 1:32:51Rich Roll?

  Like Bronner's or?

• 1:32:52Robynne Chutkan?

  We use Bronner's sometimes. We use Bronner's for our dog Hugo, but I use oil based soap. It's a no brand from Whole Foods. It just has a couple of ingredients in it. It's got some shea butter and. A couple essential oils in it and it's super mild, it's unscented. So that's good. I'm into sort of the nooks and crannies for the soap, but the rest of my body. So I'll, if I've gone for a run or something, I'll use that a little bit. My underarms and below the belt, but the rest of the body just gets a little bit of water.

• 1:33:22Rich Roll?

  And what about, what about in terms of water, like water from the faucet, chlorinated water?

• 1:33:27Robynne Chutkan?

  Yeah, chlorine filter is a great idea.

• 1:33:29Rich Roll?

  Right. And what about like the, the drinking water from plastic bottles?

• 1:33:34Robynne Chutkan?

  Yeah, the plastic is really a problem because in addition to the BPA, the plastic just degrades over time, particularly in a place like DC where it gets really hot, plastic sitting in your car. I'm a big fan of the swell water bottles. We have a bunch of those. We use them. Send my daughter to school with it for PE and she just fills it up every day. So just from, also if you think of our carbon footprint and being a little more environmentally aware too, and trying to reuse things as opposed to a plastic bottle that you're going to throw away.

• 1:34:02Rich Roll?

  And, and what's going to happen to me because I've spent most of my life in chlorinated swimming pools? Like what is this doing to my skin and to my microbiome?

• 1:34:11Robynne Chutkan?

  Well, you know, Richard, you're none the worse, Fred. I mean, you're looking like you have a really healthy microbiome hair.

• 1:34:16Rich Roll?

  I think, I think you need to take, you need to, I need to get a sample.

• 1:34:20Robynne Chutkan?

  We can do the Ubiome kit. I have one hair. Did you ever do that?

• 1:34:23Rich Roll?

  No, I haven't done that.

• 1:34:23Robynne Chutkan?

  Oh, you should do it. It's really fascinating. So I think a lot of this for you has been canceled out by all the healthy sweat and the good plants you've been eating. But, you know, to be honest with you, I'm a little scared of the pools because of all the chlorine. Not so much the bacteria, but the chlorine. When I come out of the pool, I just, my skin feels crazy. And I really noticed the difference. I swim in a saltwater pool from time to time and there's a huge difference there. I mean, I think it still has some chlorine, but a lot less. But I noticed the chlorine, my skin is red. I have rosacea. It's always really active when I get out of the pool, the hair.

• 1:34:56Rich Roll?

  Your skin really dries out and your hair gets fried and all that kind of stuff. But I know that when I'm swimming a lot, then I don't need to use like deodorant because the chlorine fries everything out.

• 1:35:05Robynne Chutkan?

  Cause there are no microbes alive on your body.

• 1:35:07Rich Roll?

  Right, right, right. But, but setting aside the swimming pool stuff, so like when I'm working out. Not a lot like like how often like I've tried to do the thing where I don't shower that much right and I'll just like I'll go on a ride sweaty I'm hot and I rinse off I put my clothes on but I feel all like sticky and like kind of uncomfortable like are there ways around that where I can avoid having to shower twice a day every single day or just to rinse off and without using all the soaps and the astringents or what is the recommended?

• 1:35:39Robynne Chutkan?

  If you can air dry that helps a lot I go to a heated vinyasa flow yoga class here in DC and I'm really sweaty at the end of a 90 minute class and it's amazing if I can I mean it's not always doable depending on the weather we've had nonstop rain for about four days in DC but if I can walk around and air dry and just change my clothes I really don't smell I mean I was running joke with somebody I work with at the hospital who's like you just think you don't smell that's because nobody's close to you but but I really don't so if you can allow yourself and if you can do a quick rinse and allow yourself to air dry particularly the moist areas like under your arms and your groin if you can that could make for you know sort of an interesting podcast about

• 1:36:20Robynne Chutkan?

  how you air dry your knicks and crannies but if you can let things dry because it's the moisture often where then you get a lot of bacterial building up or if you look at the stuff you're working out and in the clothes you're wearing so wearing natural fibers like linen and cotton you get a lot less stink than you do from synthetic fibers where the bacteria can really reproduce

• 1:36:41Rich Roll?

  Right I mean I've been in the you know I've done that where I've like I go running like I'll be at a trail and like I just have to go straight to work and I'll rinse off as best as I can I put my clothes on but I'm thinking yeah but Robin would say this is good like I'm working I'm improving my microbiome by doing this you know like I'm repeating that mantra in my mind even though I'm like I don't I feel like I want to rinse all this stuff off

• 1:37:02Robynne Chutkan?

  Well a lot of it is so cultural too you know I went to boarding school in France for a little bit and

• 1:37:09Robynne Chutkan?

  When I first got there, I lived with a French family and we bathed once a week and they, you know, turned on the hot water heater and were able to take a bath. And it was just, I mean, people didn't smell bad, but there was just, people didn't smell like a bouquet of flowers either, you know, and that was just sort of normal that if you, somebody had a little bit of a scent, it just wasn't a big deal. We're really, we're very culturally opposed to that in the US, I think. I think we have this idea that we should smell like a bouquet of roses and it's very hard to, it's hard to fight against that all the time. And there are definitely times that I pull out my Chanel number five and I spray it all over because it smells really good. But there's also denatured alcohol in it

• 1:37:51Robynne Chutkan?

  and other things and it's arguably not great for the microbiome. So that's probably not a good idea to do all the time. There's so many good products out there now. There are distillates of different essential oils that you can spray on that are very gentle to microbes and aren't destroying the microbiome. There are just so many different products out there now compared to, I think, 10 years ago that you can find. There are deodorants, not antiperspirants, but deodorants that use essential oils that are very mild, but that can give your nooks and crannies a little bit of a good scent if you're worried about that.

• 1:38:29Rich Roll?

  What would be a good deodorant? Or should we just get the book? And do you have it listed like product names?

• 1:38:33Robynne Chutkan?

  I do have some products. I mean, I'll tell you what I use. When I do use stuff, I use Dr. Hauschka, which, or as one likes to say, why does your deodorant cost $26? So I use it. I use it really sparingly. I use that. Or I like a brand called Benedetta, which is from California, and they, they make these hydro salves, which are again, a little distillate of essential oils. And I use a neroli and a lavender and I'll spray that on.

• 1:38:58Rich Roll?

  What about toothpaste?

• 1:38:59Robynne Chutkan?

  Toothpaste does it, you know, I was shocked to find out how many brands of toothpaste contain trichosan. That was pretty shocking. This, you know, you think, okay, well, trichosan's in hand sanitizer, it's on your skin, but you can actually be ingesting it. So I try to pick a brand that has the least number of objectionable ingredients. We use Toms.

• 1:39:17Rich Roll?

  Right, yeah, that's what we use. We use Toms. Because I would imagine like, that's not necessarily a microbiological like environment that you, you want to clean that, right? Like, otherwise you get bad breath, you get infection, you can get abscesses, you get tooth decay, like all these sorts of things, right? Like, so.

• 1:39:39Robynne Chutkan?

  But that's usually from the diet. I mean, in cultures that don't eat sugary starch, you know, cultures that don't eat refined sugar, they don't have dental caries and stuff like that. They don't get abscesses and so on. So a lot of that is a sugar in our food that's sticking to our teeth. But given that we, many of us are eating something, if not exactly the standard American diet, you know, we're eating some sugar. We're not living in this sort of sugar-free world. You do then need to make sure that you're doing something to, to balance out that bacteria. But again, the mouth, kind of like the gut, I mean, the mouth is one of our more robust organs in terms of the microbiome, and you have to be careful with the imbalance. The other day, my husband's pretty good with

• 1:40:23Robynne Chutkan?

  the whole live dirty thing, but the other day he came home with some mouthwash, and he was gargling with it, and I was like, stop! Don't do that! That's really bad! He looked at me like, okay, just a little crazy hair, but.

• 1:40:36Rich Roll?

  Who do you think you married?

• 1:40:37Robynne Chutkan?

  Yeah, but they, you know, the mouthwash, like, why? You don't need that. I mean, just brush your teeth. You don't need to.

• 1:40:43Rich Roll?

  That's just basically eradicating everything, right?

• 1:40:46Robynne Chutkan?

  It has alcohol in it.

• 1:40:47Rich Roll?

  Yeah.

• 1:40:47Robynne Chutkan?

  Most mouthwashes, which are not great for the microbiome. So again, you know, it's your point about these things that we do, we don't really think about. It's like, oh, we've just always done this. You know, somebody told us somewhere along the way, usually on the TV, that this is what we should do. And this equation of cleanliness equal health has been a message for a long time, and. You know, some of these companies have sold a lot of personal care products on that equation that cleanliness equal health.

• 1:41:17Rich Roll?

  Hmm.

• 1:41:18Robynne Chutkan?

  So it's hard to dial it back.

• 1:41:20Rich Roll?

  Right, right, right. What was I gonna ask you? I just had this great idea that I just lost my train of thought completely. Well, let's talk about, I'll think of it in a minute, but let's talk about the sexiest thing of all of this, which is, oh, no, I know, I just remembered what it was. In your book, you said that when a patient comes in to see you, that sometimes you can figure out what's going on with them just by, because you can smell them?

• 1:41:47Robynne Chutkan?

  Yeah.

• 1:41:48Rich Roll?

  Is that true?

• 1:41:49Robynne Chutkan?

  Well, it's not just when they're sitting in my office. It's when I'm doing colonoscopy on them. Yeah.

• 1:41:54Rich Roll?

  Okay, well, that's a little different.

• 1:41:56Robynne Chutkan?

  That I, so when I'm really sort of getting up close and personal with them, when I put the scope in, even before I see the inflammation, I can smell that their gut bacteria are totally off. I wish I could do it just sitting across from them in the office, but, but I really can't, but it's during colonoscopy. And, you know, I noticed this, again, it was one of these things I noticed for a long time, and I would talk about it with the nurses and the staff, and people thought I was crazy, like, oh. And then there was an article, a study from Japan, where they use gas chromatography to look at the microbiome in patients with Crohn's and healthy control patients, and they were able to show the clear differences using this gas chromatography. So then I was like, well, I'm just like a gas chromatograph. You don't need gas chromatography when you have my nose around. But yeah, it's dramatic.

• 1:42:41Robynne Chutkan?

  I mean, and it doesn't, you know, one could argue that nobody's GI tract smells good, right? It didn't, nobody smells like a bouquet of roses up there, but it smells off. It's different. And it's funny to talk about stools smelling bad, because people say, well, doesn't all stools smell bad? But it really doesn't. So when there's a lot of inflammation...

• 1:42:59Rich Roll?

  Completely related to, you know, your health and what you're eating.

• 1:43:01Robynne Chutkan?

  What you eat when you're micro...

• 1:43:02Rich Roll?

  I mean, when I change my diet, that totally changed.

• 1:43:12Rich Roll?

  What is your opinion on colonic? That's sort of like sanitizing, you know, I would, I would think you're probably against that, right?

• 1:43:19Robynne Chutkan?

  Well, this, colonic's, I think, are based on the idea that the colon is dirty and it needs cleansing. And that's not really accurate. So the colon is full of, you know, trillions of bacteria that are really an essential part of the ecosystem and really vital to the health of the colon. So people who are chronically constipated, or maybe are not eating a great diet, often feel good when they do a colonic and they remove all this debris, but they're also removing-

• 1:43:46Rich Roll?

  There's a lot of blockages and all kinds of stuff in there, right? That gets backed up-

• 1:43:49Robynne Chutkan?

  There can be, but you're removing a lot of the microbes, particularly if you're doing a high-pressure colonic. So what I prefer to tell people to do is just to do a simple juice cleanse or something from above, because it's like plumbing. And if the pipes are clogged, you know, just running some thin liquids through them can help. So doing a couple of days of a broth or a green juice can help to sort of move things through without that heavy-duty washing out all the microbes. So I'm a little wary of the high-pressure colonic's in particular. And sometimes people are putting things in there, like the caffeine enemas that people use to help dehydrate them for weight loss. Not a great idea, running that stuff through. So I think the bigger issue, I mean, the, the risk of colonic's in terms of perforating the colon and death, those are so rare.

• 1:44:34Robynne Chutkan?

  That's, that's not an issue. But again, removing, even a bowel prep for a colonoscopy, you know, when we have people do a bowel prep and we, we have to get everything out so we can see, I worry about that, too. I usually recommend people do a, a good course of probiotics after, even though I'm not sure that that's completely balancing it out, as we talked about. I mean, the, the bowel prep doesn't contain antibiotics, but it is a pretty heavy-duty rinse-

• 1:44:59Rich Roll?

  Right.

• 1:44:59Robynne Chutkan?

  -of the colonic content. So the same way, I don't think your skin is dirty and your hair is dirty and it needs to be super sanitized, I don't think the colon needs to be super sanitized either.

• 1:45:08Rich Roll?

  Yeah, interesting. I saw the craziest ad on TV the other night at the hotel. It was one of those pharmaceutical ads, but it was so over the top. It was for something. If you see this called, it was to treat something called opiate induced constipation. O I C. Do you have O I C? And it was a drug to help people loosen their stool. Because they're addicted to opiates, which causes the constipation. I was like, this is insane.

• 1:45:33Robynne Chutkan?

  A drug to treat the side effects of a drug.

• 1:45:35Rich Roll?

  Yeah, it's a drug to treat the side effects. Like if you're addicted, if you're like a Vicodin addict, you know, and you can't go to the bathroom, then you need to take this drug because we've we've created. Now we have a name for this. I know exactly, right? Like, I'm like, oh, my God, it's getting crazier than you. It was like a Saturday Night Live, you know, ad.

• 1:45:53Robynne Chutkan?

  But it's like the dry skin because you use the toner and you strip away all your oil. And now you have dry skin and here's a moisturizer. I mean, there's, you know, our, our daily routines are full of these rituals. That sort of don't make any sense.

• 1:46:06Rich Roll?

  Well, it drills down to at its core, it goes, it goes back to this reductionist approach to science and medicine. Right? Like, you know, and that applies to antibiotics. It's like, here's something wrong with you. Here's this thing that will fix it. And we have blinders on thinking that like, there isn't like massive ramifications in all different kind of directions that we're not really looking at, right? It's a one to one. We're in this dualistic kind of mentality about it. But that's not the way we function. That's not the way our bodies work. And that's not the way that, you know, food works, our microbiome works, or any of these drugs work that we're taking.

• 1:46:41Robynne Chutkan?

  And that really is the point of the book and really why I'm here. It's not, I'm not anti medicine at all. I'm not anti antibiotic. I'm for judicious use of stuff and for really giving people the information to say. I had somebody email me today about a friend about his child who had.

• 1:47:00Robynne Chutkan?

  Been in a little bit of an accident and a lot of the skin was removed off the heel and the doctor's recommending antibiotics and he wasn't sure what to do. And I said, well, can you send a picture? And he sent the picture and it was really deep and scary looking. And I said, you know, I, I am all about judicious use of antibiotics, but this is a really deep cut. And it wasn't just a cut, like the skin was off and it was on the foot. And I was like, I don't know, you're gonna have a hard time keeping this clean. I mean, maybe you could use awesome for a narrow spectrum antibiotic, use it for less time. So there are lots of times where, you know, it is prophylactic, but it's probably the right thing to do because if that gets infected, that's a really bad idea. But there are so many areas where people just don't have the information. People don't know. I didn't know, I was a physician prescribing antibiotics.

• 1:47:45Robynne Chutkan?

  I didn't know every time I prescribed a broad spectrum antibiotic, again, one of these sort of super duper antibiotics, that I was removing a third of my patient's gut bacteria in five days. And then that was setting them up potentially for things like food allergies and asthma and autoimmune diseases. So it's really arming both the lay public as well as physicians because we're lacking a lot of this information. Is that changing? With the information. It is changing and I think it's changing because of people like Dr. Martin Blaser, who wrote a great book, Missing Microbes, last year. Read it after you read mine. So Marty Blaser is the chief of infectious diseases at NYU. He's been president of the infectious disease organizations in America. He's not some, you know, naturopathic doctor who no one's ever heard of,

• 1:48:29Robynne Chutkan?

  who's on, on a, you know, saying that drugs are bad. He's a very well-respected clinician and researcher and he's waving the red flag and saying, this is really a problem. So I think it changes when people like that, when people like me who are conventional doctors who are not opposed to these drugs, but we're saying, we're overusing these drugs, we're using them in the wrong circumstances. And lots of people have been saying that. But I think when you have people who are sort of more conventionally trained saying it, it carries a little more weight. It shouldn't have to, but, but it does because we're not naturally opposed to this stuff. And we've been prescribing it and now we're seeing the ramifications. So I think it slowly is changing.

• 1:49:13Robynne Chutkan?

  President Obama had a, has created initiative to try and cut down on the amount of resistant superbugs that we're seeing. And so he has a An act before Congress where really trying to cut down on the use of antibiotics, both in food as well as antibiotics that are being prescribed. And that's for the bigger problem of resistance to antibiotics in the general community. But of course, it's going to help individuals to just take fewer antibiotics. So we're seeing the government paying attention and that's always a good thing.

• 1:49:43Rich Roll?

  Right, very cool. All right, fecal transplants.

• 1:49:46Robynne Chutkan?

  Yes.

• 1:49:47Rich Roll?

  We gotta get into this.

• 1:49:49Robynne Chutkan?

  You know, this is like the best thing that ever happened to me because I was known for years as a doo doo doctor. And you know, I'm always like asking people, well, bring a picture of your stool. My cellphone is full of photos of my stool, my daughter's stool. None of my husband's, he won't give us any snapshots. But patient stool, when patients bring me pictures of their stool, or even better, a specimen, I get really excited. And people just have thought this is so gross. So to now have people saying like, tell us about stool, give us some stool. It's, it's real validation for me. But stool transplants are not new. People think they're new, but they are, we have precedent in the animal kingdom where certain animals will eat the stool of older animals in the herd to acquire essential microbes.

• 1:50:34Robynne Chutkan?

  So that's something that happens very commonly. There's certain-

• 1:50:37Rich Roll?

  Yeah, so when my dog wants to eat, you know, his own stool or the stool of his, his, you know, friend dog or something is like, is that something that you should say no? Like, what's going on there?

• 1:50:50Robynne Chutkan?

  It has to do with the age of the dogs. When we got our puppy, he was digging up old dog poo and eating it and getting sick and vomiting at four in the morning. So we had to put an end to that. But, and it's hard because these animals are domesticated, so their patterns of doing things are different from what they do in the wild. But when they've studied animals in the wild, several different kinds of animals, elephants, pandas, all kinds of different animals, that is clearly a behavior that confers a survival advantage or actually acquiring microbes from elders in their herd that have a mature, more mature microbiome. But in domesticated animals, it's hard to know because, you know, their, their environment is so altered.

• 1:51:29Robynne Chutkan?

  But there, there are tribes like certain, certain sects within the Bedouin will eat camel feces when they have dysentery and diarrheal illnesses to cure that. So even within humans, there are, are examples of coprophasia of eating stool for health reasons. And in medieval times, physicians used to taste urine to see if it was sweet to diagnose diabetes and had been even known to taste stool. But I'm not resurrecting that practice. I'm just sending stool to a good lab for right now.

• 1:52:01Rich Roll?

  But the idea is that you get somebody's magical stool and this is like a turbocharged probiotic.

• 1:52:07Robynne Chutkan?

  It's like a super probiotic because here's a rub. We don't know all the microbes that are in stool. We know a lot of them, but we probably, there are probably hundreds more that we don't know.

• 1:52:17Rich Roll?

  Well, one drop, right, of your, your sort of fluid in your gut has a million microorganisms.

• 1:52:24Robynne Chutkan?

  Yes, exactly. More.

• 1:52:25Rich Roll?

  A billion, actually.

• 1:52:26Robynne Chutkan?

  A billion, yeah. A drop of fluid from your colon. So this is really potent stuff. And so we can only culture and grow outside the colon, the ones that we know about and we know how to grow them. But there are probably hundreds more. It's sort of like food. So if you think of, if you do a study and you say people who eat tomatoes have healthier hearts and they have fewer heart attacks. And then you say, well, and lycopene is in tomatoes. So I'm going to just take a lycopene supplement. Well, it could be lycopene, but it could be one of a thousand other things that are in a tomato that you don't even know about. So of course the answer is to eat tomatoes, not to take the supplement. So it's sort of the same analogy. If the idea is that, well, a probiotic has some of these bacteria that are healthy and good for you in it, but there are a lot more in the stool that we don't know

• 1:53:10Robynne Chutkan?

  about. Maybe we should just get the stool back.

• 1:53:12Rich Roll?

  Go right to the source.

• 1:53:13Robynne Chutkan?

  But there, you know, it's, it's not all.

• 1:53:15Rich Roll?

  How does it work? Like, you do it, you put it in capsules?

• 1:53:19Robynne Chutkan?

  I can, I can go, we can go into the.

• 1:53:20Rich Roll?

  A suppository? Like, what are we talking about?

• 1:53:22Robynne Chutkan?

  You're super interested in this, right? We can go into the details of how we do it. But the first thing I want to tell people is that. Stool transplants also come with some risk because there is something, remember stool is waste matter.

• 1:53:34Rich Roll?

  It's like a blood transfusion, right?

• 1:53:36Robynne Chutkan?

  Exactly. So you can transmit viruses, various things. And again, just like we don't know all the good things in stool that might be helping, we don't know all the bad things in stool, too. We recommend stool transplants from intimate contact, shall we say, where you've already swapped body fluids. So you're already, you know.

• 1:53:53Rich Roll?

  Putting it very politely.

• 1:53:54Robynne Chutkan?

  What Julie has, you already have. So she would be a good candidate, plus she looks really healthy and eats a great plant-based diet. And she's from Alaska, which is a healthy state.

• 1:54:03Rich Roll?

  Well, isn't there that thing, like, like, there's fecal matter all over the place, right? Because people don't wash their hands.

• 1:54:09Robynne Chutkan?

  Everywhere.

• 1:54:10Rich Roll?

  Like, we worry about cleaning certain things, but like, you know, really our cell phones and all those sorts of things are covered with stuff like that.

• 1:54:16Robynne Chutkan?

  Cell phones, money, it's everywhere. So the stool transplant, the most important thing is the quality of the donor. Because if you're getting stool from somebody who's been, you know, eating at McDonald's every day and taking antibiotics.

• 1:54:28Rich Roll?

  How do you qualify the donor? Like, who are these super donors?

• 1:54:30Robynne Chutkan?

  Well, I'm kind of partial to foreign-born myself. Because, you know, again, if you look at prescribing patterns and so on, people from the developing world are more likely to have eaten a less processed. A blue zone, yes. I'm partial to the Amazon and the Hasda and Tanzania. But, but you want, you want good quality stool. And by good quality, again, less processed food, less antibiotics, more plants, ideally.

• 1:54:55Rich Roll?

  See a whole market emerging out of the developing world.

• 1:54:59Robynne Chutkan?

  Absolutely. You know, at one point, I considered stuffing myself full of as much kale as I could to be a donor for my patients, but I, I abandoned that because I thought, gosh, if I transmit something bad to you that I'm unaware of, I'll be really upset.

• 1:55:13Rich Roll?

  Right. And you'll end up on 2020.

• 1:55:15Robynne Chutkan?

  But there, you know, there are, there are a couple cases of that. So for example, at Emory University, when they first started doing their stool transplant program for C. diff, they were using one of the post-docs was the stool donor. It's helpful to have a small pool of donors. We use, Georgetown, we use a company called Open Biome, which is a nonprofit based in Massachusetts, as a donor for people who don't have an appropriate donor. They go through a very rigorous process to screen their donors and they save aliquots of stool so they can trace it back if we think that we've transmitted something. They can go back to that original sample and see what's growing in there. So it's really important that people often say, well, my husband would be a good donor. My wife's been be a good donor.

• 1:55:58Robynne Chutkan?

  We do very specific testing for HIV and syphilis and hepatitis and lots of things in the blood as well as in the stool. But even though we are then able to say, okay, you don't have any of these things. Again, we don't know, well, there might be hepatitis Q that we discover five years from now. We don't have a test for now. And also, we still don't know, is it good quality? We can only sort of guess at that based on the person's history and habits. So having access to donor stool when we're using it to treat serious things like C. diff infection is helpful because we can actually really test that stool and say, well, it's got high numbers of bacteroides and low numbers of fermentutes and that seems to work better, whatever other analysis we do.

• 1:56:42Robynne Chutkan?

  But the other thing about a stool transplant is you have to be clear on what the benefit is. You know, stool transplant, I would not recommend that because you're trying to clear up your rosacea or you have a little bit of gas and bloating. You really have to look at what are the diseases where we have data to show this is helpful? We have overwhelming data for Clostridium difficile infection, C. diff, which is the infection that develops when people take antibiotics and it allows this sort of bad bacteria to overgrow and can develop serious infection in the colon and even death. So we know from the studies a couple of years ago that stool transplants are vastly superior to antibiotic treatment, as one would infer, since antibiotics sort of got us into that pickle to begin with.

• 1:57:27Robynne Chutkan?

  And, and that is a standard of care and the CDC has declared that's a standard of care for refractory C. diff infection. That's clear. There's a lot of data for inflammatory bowel disease, Crohn's disease and ulcerative colitis, but it's still the FDA, which is having difficulty figuring out how to classify stool transplants. They first said they were medical devices and we all kind of said, what? They're not drugs. So it's a, it's a new category in terms of how do you, how do you categorize it and how do you regulate it and how do you make sure that people, just like antibiotics, that they're using it judiciously and people aren't going around.

• 1:58:01Rich Roll?

  It would be, how do they categorize a blood transfusion?

• 1:58:05Robynne Chutkan?

  Yeah, it should be very much in the same, except that you can't do a blood transfusion easily yourself at home and you can, you know, that requires you sort of going somewhere to do it, whereas you can do a stool transplant pretty easily. So for C. diff, they were historically done via colonoscopy, which is a pretty cumbersome way to do it, having to have a procedure and be sedated and so on. So stool enemas and for C. diff as a one-time procedure where we want to examine the colon and see the condition of it and give the enema at the same time, that's still often how we do it. But for some of these chronic conditions like Crohn's disease and ulcerative colitis that are still a little bit in the gray zone, but the evidence is mounting, that stool transplants can be helpful for IBS, diarrhea,

• 1:58:48Robynne Chutkan?

  predominant irritable bowel syndrome. People do them at home via enemas. And I have a whole chapter on that in the book where I describe the equipment you use, how you prepare the donor stool, how you insert the enema, what you do with the bag, reading material. If you've not read my first book, Gut Bliss, it's a great idea to read that while you're doing the transplant. But it is, you know, it is, it still has to be evidence-based. It can't be that, oh, this is a good idea, so you should try this because again, there's potential risk like there is to a lot of these things.

• 1:59:23Rich Roll?

  Right. All right. So if somebody's listening and they're like, well, I don't know if I have, you know, I don't have ulcerative colitis, but how do I, you know, gauge the health of my gut? And they don't live in Washington DC, so they can't come and see you. Where do they go? Or what are the resources available?

• 1:59:39Robynne Chutkan?

  Well, there are a couple of good ways to actually assess your microbiome. There is a kit called, a company called Ubiome that sells a kit. You can actually get it on our website, gutbliss, G-U-T-B-L-I-S-S dot com. And you can get this kit and they mail it right to you and you register it online and you swab the toilet paper after a bowel movement, which is kind of nice. You don't actually have to collect a stool sample. You swab the toilet paper and you send that off and a few weeks later, they send you your results. So there are four main phyla of bacteria we see in the gut. We see bacteroides, firmicutes, actinobacterium. Bacteria and proteobacteria is the four main ones. And when I look at that and I look at the ratio, particularly of the bacteroidities to the firmicutes, we can infer a lot about

• 2:00:24Robynne Chutkan?

  what's going on in the microbiome. So there are ways we can actually test. We can also test for pathogens. We use a lab in Arizona to look for parasites and yeast overgrowth and so on. So it's usually two part. Number one, we look to see if there are any pathogens there that shouldn't be there that we need to think about rebalancing. And then we look at the normal microbiome and see what are the normal constituents of the gut for this particular person and do we need to do some rebalancing and fine tuning there. So it's kind of cool, this whole empowering of the citizen scientist. And you don't need me to order that test. You can, you can get online and order your own Ubiome kit and check out your microbiome. And then you can do a plant based experiment and go vegan for 90 days

• 2:01:08Robynne Chutkan?

  and see what happens to your microbiome, or you can cut out refined sugar, or you can do it again after you've had a course of antibiotics, if that ended up being something that you couldn't avoid. So again, being able to educate people about this and say that, you know, you, there's a way to actually look at this and to see how it's changing over time. And we're all participating in this giant experiment because

• 2:01:31Rich Roll?

  Right.

• 2:01:31Robynne Chutkan?

  we still don't really know what the normal microbiome looks like. It's more a matter of what's normal for you. And that, again, your microbiome reflects everything about you, how you were born, whether you were breastfed or not, where you've lived, your profession, the food you've eaten, the drugs you've taken, your hormones, the stress in your life, whether you've had a pet, whether your brothers and sisters teased you, all of these things.

• 2:01:53Rich Roll?

  Yeah, it's more, it tells the whole story, more than, almost more than your DNA.

• 2:01:57Robynne Chutkan?

  More than your DNA, which is amazing.

• 2:01:59Rich Roll?

  Yeah. Well, if somebody, if somebody's listening and they, they are having, you know, autoimmune issues or are suffering in some regard that perhaps is linked to, you know, the health of the microbiome, is there a place online, I mean, they can go to gutless.com, there's tons of resources there, and of course, reading your books. But in terms of finding a practitioner who is, you know, receptive and experienced, that is there a place where there's a listing of people that are?

• 2:02:27Robynne Chutkan?

  You know, there are a lot of clinics that do this. There are a lot in the UK. There are a lot in the West Coast. But what I found with a lot of the clinics is they kind of take all comers and that's not necessarily the best approach. I'd really recommend that people try and get into a clinical trial. So there are several at NIH. They have some in Boston, at some of the Harvard hospitals. Hopkins has a good clinical trial for inflammatory bowel disease because it's really important to do this in a very measured way. And the clinical trials, usually there is a group that's getting the stow transplant and then a placebo group. So they're looking at, you know, what's the difference in people who are getting this versus not getting this, which is an important question to answer. Are you actually any better off than if you're getting just an enema of saline?

• 2:03:12Robynne Chutkan?

  But for most of these clinical trials, then there is an open label period at the end where if you didn't get the stow transplant, you can get it at the end. So I really encourage people to be part of these clinical trials because again, you're contributing to the scientific body of knowledge too, which is really important.

• 2:03:27Rich Roll?

  Right, right, right. Okay, cool. And we can close it. We're gonna, we're gonna wrap it up here in a second here. You've been very gracious with your time. But I think it would be helpful to leave people with perhaps, you know, some of the top, like, what are the main things that people can kind of take away and like, sort of immediately change in their daily experience? Like if they're here, if you just did like these three, four things, five things, whatever it is, you can, you can start to, you know, really kind of like improve the health of your microbiome and, and, and realize the benefits of that in your overall health.

• 2:04:05Robynne Chutkan?

  So I have a list of 10 things to ask your doctor if you've been prescribed an antibiotic. And I, I don't want to tell people just sort of, you know, carte blanche, say no to antibiotics because there are times you might need one. But you have to really press. You have to really say, do I need this antibiotic? What would happen if I didn't take this antibiotic? Are you treating me based on an actual result or are you treating me preventively? Has whatever it is I'm growing that needs to be treated been cultured and ID'd? And is it really sensitive to this antibiotic? You have to really press because the studies show that physicians prescribe antibiotics, at least in the pediatric world, 67% of the time when they think the patient expects

• 2:04:46Robynne Chutkan?

  it and 7% when they don't. So there's a big, big, lots of leeway to not have an antibiotic. And because antibiotics are just sort of, you know, so destructive to the microbiome. So that's number one is to really judicious use of antibiotics and to really press. And as part of that, to make sure you're not using antimicrobial products when you don't need to, like in your household cleansers and your shampoos and your soap and your, you know, it used to be that antibacterial was good and helped to sell products. I remember somebody trying to sell me yoga clothes that were antibacterial. And now antibacterial is kind of a slur. So make sure you don't, you're not using cleaning products on your person or in your home, on your dog, on your child that are antibacterial because really a bad

• 2:05:29Robynne Chutkan?

  idea. So that's the second thing. And definitely throw out the hand sanitizer. A little bit of dirt is a lot better than those chemicals. If you are in a situation where you've been visiting somebody sick or in the hospital, just use regular soap and warm water. You know, I'm not saying don't wash, but not the, not the hand sanitizer stuff. And again, just a sort of gentler, cleaner approach to our own personal hygiene is part of that. You have to look carefully at the food you're eating. Does it contain antibiotics? Is it doing anything to help your microbiome? Is there enough indigestible plant fiber in it? That's another,

• 2:06:09Robynne Chutkan?

  another important thing. And, um, yeah, it's, you know, I would, Rich, I wish I had some like really super sexy thing to say like, oh, just, uh, put argan oil on your, onto your chin or

• 2:06:24Rich Roll?

  The truth doesn't work that way. I mean, that's all like, look, increase your, yeah, increase your plant fiber. Stop like, you know, chafing your skin with all these astringents. You know, I mean, it's, it's simple things that I think, you know, these are things we all do every single day and we can start to make shifts in them, you know? Yeah, it's great. Thank you so much. Thank you. This was so much fun. I have one, will you indulge me for one final question?

• 2:06:45Robynne Chutkan?

  Of course, of course.

• 2:06:46Rich Roll?

  Every time I have a doctor on the show, I ask this question. If you were to wake up and find yourself to have been appointed to be surgeon general, what kind of changes would you make, regulatory or legislative or just policy wise?

• 2:07:01Robynne Chutkan?

  That's sort of a fun question for me because it almost happened. I was on the shirtless last year.

• 2:07:05Rich Roll?

  Were you?

• 2:07:06Robynne Chutkan?

  Yeah, I was one of three.

• 2:07:07Rich Roll?

  I didn't know that.

• 2:07:08Robynne Chutkan?

  I was in and out of-

• 2:07:09Rich Roll?

  Well, I see this picture over here of you with Michelle and President Obama.

• 2:07:13Robynne Chutkan?

  I was in and out of-

• 2:07:14Rich Roll?

  So I know that you guys are acquainted.

• 2:07:15Robynne Chutkan?

  Well, Christmas party, but I was in and out of HHS and White House interviewing and I, you know, at the end of the day, obviously, I did not get the job and I think they made a great choice with Vivek Murthy. But it was really fascinating because I had to think about exactly those questions, a lot about those questions. And the number one thing is that we are relying too much on pills and procedures. And I understand why. There is a lot of commerce in that. It is very enticing, the idea that you just take a pill or you have a procedure. We have to really dial that back and we have to re-educate people on, quite frankly, the power of being ill. This idea that, you know, when you're

• 2:08:00Robynne Chutkan?

  sick, you get into bed with some broth or some tea or some green juice and you just suffer through it a little bit. So, you know, people, it's, people think that, people are really just misinformed about how medicine works and it's not magical. You know, we can't just sort of make you not have a cold. We can't make things disappear. And I think that's what we've been led to believe. And we, as physicians, have led that charge, that we have these magical powers and we can eradicate illness. We can do a lot about some really bad diseases, but there are a lot of basic things we can't do anything about. And in our attempt to try and control things and eradicate things, we are often making things worse. So-

• 2:08:42Rich Roll?

  It's an analogy for life.

• 2:08:43Robynne Chutkan?

  We need a campaign to sort of re-educate people about health and disease and the relationship between the two and dialing things back a little bit. I mean, we need better policies so that people can stay home with their kids when they're sick and so their kids can stay home from school. And this, I mean, I have people coming in all the time saying, "I can't be sick." And I'm like, "Well, you have to be sick because I don't have a magic wand to wave."

• 2:09:06Rich Roll?

  Right, right.

• 2:09:07Robynne Chutkan?

  So I'd like to see more- Basic education about the relationship between how we live and how we feel. Instead of this sort of magical paradigm that, you know, we have a pill for every ill and no one needs to be sick and no one needs to suffer because it's not true.

• 2:09:21Rich Roll?

  Yeah, we can't, we can't be in denial. Like, sometimes we get sick. It's okay, just accept it as opposed to trying to pretend that it doesn't happen or to just make it go away or to take a drug that takes away the symptoms and makes you feel like you're not ill when you actually are.

• 2:09:38Robynne Chutkan?

  Yeah, masking things.

• 2:09:39Rich Roll?

  Yeah. It's great talking to you.

• 2:09:41Robynne Chutkan?

  Thank you, Rich. Thanks so much for coming.

• 2:09:43Rich Roll?

  We did it.

• 2:09:44Robynne Chutkan?

  We did it.

• 2:09:45Rich Roll?

  Are you okay?

• 2:09:46Robynne Chutkan?

  Are you gonna, are you gonna, you know, my daughter was really disappointed that you didn't run, swim and bike here. So are you gonna like?

• 2:09:51Rich Roll?

  I don't know. Yeah.

• 2:09:51Robynne Chutkan?

  Hop into Rock Creek Parks and the Telltale.

• 2:09:54Rich Roll?

  I'll like tell her I'm running back and I'll get the, I'll hail an Uber from the corner, but she'll think that I'm running home.

• 2:09:59Robynne Chutkan?

  Well, there are times when it's actually not good to be too dirty and swimming in the Potomac River is probably not a great idea.

• 2:10:06Rich Roll?

  Yeah, I don't think I'm gonna be doing that.

• 2:10:08Robynne Chutkan?

  I think that's overdoing it.

• 2:10:09Rich Roll?

  But, uh, thank you so much for your time.

• 2:10:11Robynne Chutkan?

  Thank you.

• 2:10:11Rich Roll?

  Cool. So, uh, obviously you know, the books are Gut Bliss and The Microbiome Solution. If you want to connect with Robin, uh, she's on Twitter at Dr. Chutkan. How do you say it? Chutkan?

• 2:10:22Robynne Chutkan?

  Chutkan.

• 2:10:23Rich Roll?

  Chutkan. Uh, and you're on Facebook and all the likely places, but in terms of the web, is the best place to find you at gutbliss.com?

• 2:10:31Robynne Chutkan?

  That's right.

• 2:10:31Rich Roll?

  Right. And, uh, if somebody wants to come and make an appointment with you in Washington, how would they do that? Can they do that?

• 2:10:37Robynne Chutkan?

  Absolutely. They can do that. There's actually a link that says, uh, Medical Practice on the website. And, uh, there's also the practices, Digestive Center for Women.com, although we happily see men too.

• 2:10:50Rich Roll?

  I was gonna say, why just women?

• 2:10:51Robynne Chutkan?

  Well, you know, when I, when I left Georgetown and started this practice about, um, gosh, about 11 years ago, the idea was a very integrative practice geared more towards women. But I found that men were really interested in finding out, you know, how they could change how they eat and do biofeedback and so on, improve their health. And we've been meaning to change to Digestive Center for Wellness and we just kind of didn't get around to it because the men came anyway and didn't seem to really care. But there'll be a name change happening eventually. But for now, we, we welcome our male patients and you don't have to shave your legs or do anything crazy to come and see us if you're a man. Just come on up.

• 2:11:29Rich Roll?

  All right. Good to know. Thanks. All right. Peace. Plants. The microbiome.

• 2:11:34Robynne Chutkan?

  Thank you. Live dirty.

• 2:11:36Rich Roll?

  Eat clean.

• 2:11:45Rich Roll?

  I told you she was amazing, right? I found that very fascinating. I hope you guys enjoyed it. And I want you to think about this conversation the next time that you eat, or bathe, or are shopping for cleaning products, or are prescribed an antibiotic. You might hear Robin's voice in the back of your brain, and it might influence your decision making. In any event, as always, do yourself a favor. Please check out this week's comprehensive show notes at richroll.com. Once again, I've created quite a laundry list of additional articles, books, background, and other materials and resources related to gut health and the microbiome and today's conversation. Many of these resources were provided by Dr. Shetan herself, thanks, Robin, to help you take your knowledge base and your podcast

• 2:12:29Rich Roll?

  experience beyond the earbuds. And please be sure to check out her new book, The Microbiome Solution, as well as Gut Bliss, using the Amazon banner ad at richroll.com, of course. And while we're at it, have you guys subscribed to my newsletter yet? Come on, you guys. No spam, just good stuff. Weekly podcast updates, product offers, and I'm gonna start sharing some additional exclusive content there. Helpful information, all oriented around the wisdom of my guests, and the books, the films, the products, and the resources that I'm finding helpful in my own life. So, go ahead, subscribe. And as for exclusive content, as you know, iTunes-only catalogs the most recent 50 episodes of the show. If you want free access to the entire back catalog, all 191, 92, 91, what are we on right now?

• 2:13:14Rich Roll?

  Episodes, you can do that with my free iOS app. Just search Rich Roll in the App Store or on iTunes. We're gonna be releasing a new version soon to overcome any bugginess that's going on. And yes, Android users, I hear you, we're working on an Android version. Anyway, thank you for subscribing to the show, for giving us a review on iTunes again, and always making sure to use the Amazon banner ad at richroll.com. If you guys are in the LA area, be sure to drop by Joy Cafe. It's our plant-based cafe in the Westlake region of...

• 2:13:47Rich Roll?

  Los Angeles, we're really proud of it. You can find me eating lunch there when I'm in town, three or four days a week at least. So if you want to meet up for me, that's probably the safest, easiest, most predictable place to do it. Really amazing food, prepared by the proprietor, Joy Wally, and Nick Johansson, her partner there. They're doing a really great job. I'm also partnered in a vegan and gluten-free bakery called Karma Bakery, the Karma Baker, which is also in the Westlake area. And it feels really good to serve a global audience through this podcast, but there's something really tangible and fantastic about serving my local community through businesses and interests that are aligned

• 2:14:28Rich Roll?

  with the vision of this podcast and the advocacy that I do. So, thank you for patronizing those fantastic businesses. For all your plant power needs, visit ritual.com. Check out our new cookbook and lifestyle guide, The Plant Power Way. We also got signed copies of Finding Ultra. We got Julie's meditation program. We've got 100% organic cotton garments, tech tees for running, sticker packs, fine art prints, basically all kinds of cool stuff to help take your health and life to the next level. Keep sending in your questions for future Q and A podcasts to [email protected]. Check out my online courses at mindbodygreen.com. Click on video courses to learn more about that. Got some great stuff there. And thanks for supporting the show by telling a friend,

• 2:15:12Rich Roll?

  for sharing it on social media, and once again, for always using the Amazon banner at ritual.com for all your Amazon purchases. I love you guys. Signing off from Beirut. Wish me luck in the marathon, and I'll see you back here in a couple days, everybody. Peace.