Understanding and Improving Your Gut Health with Dr. Robynne Chutkan

00:00:00.000 | For a while, I've been fascinated by how our gut microbiome can have such a visible impact on our

00:00:05.360 | lives, affecting everything from energy to immunity to inflammation and even our mood.

00:00:10.160 | But for all the buzz around gut health, it is still a black box for most of us,

00:00:14.240 | and I wanted to go deeper. So today I'm talking with Dr. Robin Chutkin, a board-certified

00:00:18.920 | gastroenterologist, founder of the Digestive Center for Wellness, and author of several books

00:00:23.800 | on the microbiome. She's treated thousands of patients over three decades and brings a perspective

00:00:28.680 | that's both clinically grounded and refreshingly practical. As she puts it,

00:00:32.700 | There is no brain health, no immune health, no lung health without gut health.

00:00:38.220 | In this episode, we're going to explore what your gut might be trying to tell you,

00:00:41.900 | from reflux or bloating to what your stool says about your health. We'll also cover how probiotics,

00:00:47.140 | fermented vegetables, hydration, fiber, and more actually impact your digestion,

00:00:51.780 | and whether washing your hands or sanitizing too much might be doing more harm than good.

00:00:56.160 | I'm Chris Hutchins. If you enjoy this episode, please share it with a friend or leave a comment

00:01:00.300 | or review. And if you want to keep upgrading your life, money, and travel, click follow or subscribe.

00:01:05.120 | Robin, why is gut health such a critical part of our health?

00:01:08.780 | Chris, I want you to look down at your belly and see where your gut is located. It is right in the

00:01:14.600 | center of your body. It is literally the engine for your entire body, for your brain to function,

00:01:21.100 | your kidneys, your lungs, your liver, your immune system. So if your gut health is off,

00:01:25.740 | it means your body is not functioning properly. Now, I know you went to Yale for pre-med,

00:01:30.420 | Columbia for med school. How much of your medical training and education even touched on the gut?

00:01:35.840 | Less than 1%. Less than 1%. And less than 0.01% of my training and education touched on what we

00:01:45.380 | should be eating and how we should be feeding this incredible engine that's fueling our entire body.

00:01:49.540 | And so what are some of the common myths or misconceptions that people might not

00:01:53.480 | be thinking correctly about their gut?

00:01:55.280 | The gut for most people is this black box. Like they don't understand it. They think,

00:01:59.860 | I'm just going to throw some stuff in there and hope that it works. So they don't understand this

00:02:04.160 | basic idea of input and output that you put in something at the top through your mouth and something

00:02:10.520 | comes out at the bottom through your anus. And everything that happens in between your mouth and

00:02:16.420 | your anus is dependent on the input. So the input really informs the output. And I think people are

00:02:22.100 | just guessing and they're just kind of throwing stuff against the wall of their gut and hoping for

00:02:27.740 | the best.

00:02:28.200 | And what's actually going on inside the gut? How do we think about all the bacteria? And I guess like

00:02:34.920 | maybe a one-on-one, a one-on-one on gut health for people.

00:02:37.780 | The first thing I want people to know is that the gut actually starts right at the top with the mouth.

00:02:42.100 | And that's where digestion happens. And in fact, even before the food hits your mouth,

00:02:46.880 | you start digesting. The sight of food, the smell of food, sometimes even the thought of food can

00:02:52.740 | start to release enzymes from our salivary glands. So as soon as a food hits the mouth, it starts to

00:02:57.560 | get digested. And of course, we chew it up in our mouth and then it travels down the esophagus.

00:03:02.600 | Food hits the stomach. It gets churned up into something called chyme. And again,

00:03:07.280 | more enzymes, gastrin, lots of different enzymes, hydrochloric acid. After the stomach,

00:03:12.460 | it goes into the small intestine. And then we get to the large intestine, sometimes called the colon.

00:03:17.340 | And one of the interesting things is that even though it's one continuous tube from your mouth

00:03:23.260 | to your anus, all the different parts work completely differently. They have different

00:03:28.120 | lining, different epithelium. So for example, in the esophagus, you have a squamous lining,

00:03:33.400 | which is very sensitive to acid because there's not supposed to be acid in your esophagus.

00:03:37.320 | In the stomach, you have a columnar lining, which is resistant to acid. Different parts release

00:03:43.040 | different enzymes. Different parts can churn up food differently. So it's very specialized,

00:03:47.900 | even though it's all connected.

00:03:49.220 | So what are some of the kind of main roles this entire gut system plays in maintaining our health?

00:03:56.380 | I'm sort of embarrassed to say that I had been a gastroenterologist about 15 years before I figured

00:04:02.740 | out this one simple, incredible thing. And that is that when something is in your GI tract,

00:04:09.240 | it's not actually in your body. It's in this hollow tube that goes from your mouth to your anus and

00:04:15.600 | bisects your body. And so one of the main functions of the GI tract beyond digesting and absorbing the food,

00:04:21.740 | it's to keep things that get into our body through our mouth. So that could be pollen, it could be

00:04:26.600 | poison, it's bacteria, it's viruses, to keep those things in this hollow tube running the whole length

00:04:33.580 | of our body and to prevent them from getting absorbed through the gut lining into our body where they can

00:04:39.880 | get through our bloodstream to different organs. The lining is not just this passive thing. It's only

00:04:44.700 | one cell thick, but it's very active. And so it kind of knows what it should let through,

00:04:49.460 | what it shouldn't. The gut bacteria help with that. So that's one of the first things. It's a defense

00:04:55.240 | to prevent things from getting into the rest of our body. And then, of course, digestion, right? So

00:04:59.860 | the food gets churned up, enzymes get released, different macro and micronutrients get passed

00:05:06.220 | through the gut lining into the bloodstream where they feed all your other organs, your brain and your

00:05:10.920 | lungs and your immune system, et cetera. We also have stomach acid, which isn't just essential for

00:05:15.700 | digestion. Stomach acid literally kills pathogens. So there was a study that was done in 2021 and it

00:05:22.880 | showed that people who are blocking stomach acid with these potent drugs called proton pump

00:05:27.460 | inhibitors, those people had a two to four fold increased risk of getting sick with COVID when they

00:05:35.300 | were exposed to the virus. Because normally when you have intact stomach acid, you swallow SARS-CoV-2,

00:05:41.440 | you can breathe it in, but you can also swallow it. And then that stomach acid unravels a viral protein

00:05:46.740 | and inactivates it. And it does it for all kinds of different viruses. It can protect you from poliovirus

00:05:52.940 | and from different bacteria. And when I say protect, I mean lower incidence compared to not like I'm

00:05:59.300 | bulletproof. I have stomach acid. Viruses can't make me sick. So that's just a huge difference right

00:06:05.340 | there. But that wasn't really news, Chris, because we knew from decades ago from cruise ship outbreaks

00:06:10.740 | of norovirus and things like that, we could always predict who would get sick. And sure, older people,

00:06:17.160 | babies, but people who don't have stomach acid, people who are taking that Nexium and, you know,

00:06:23.340 | their Prevacid and thinking, this is fantastic. I can eat a cheeseburger at 10 o'clock and I don't have

00:06:27.860 | reflux. And yeah, that's true. But unfortunately, the flip side is that it makes you more vulnerable

00:06:36.300 | to pathogens, to bacteria, to viruses, to foodborne illnesses.

00:06:40.320 | And so that's a little bit of the negative of an unhealthy gut. What are some of the positives of

00:06:45.780 | a really healthy gut that can impact your life or your health?

00:06:48.800 | I think the gut immune connection is one of the most important. And because we are seeing such an

00:06:55.160 | epidemic of autoimmune disease, we are seeing that one in four Americans have an autoimmune disease.

00:07:00.260 | So things that affect our skin, like psoriasis and eczema, things that affect our gut, like Crohn's and

00:07:05.700 | ulcerative colitis and celiac disease, rheumatoid arthritis, lupus, which can affect the joints and the

00:07:11.160 | kidneys and the skin, MS. And it turns out that our gut health is really at the heart of that,

00:07:17.360 | of that explosion of autoimmune disease. And the story of how we figured that out really comes from

00:07:24.220 | something called the hygiene hypothesis. And if we go back a little bit to the 1950s in the United

00:07:31.380 | Kingdom, they were starting to see this explosion of autoimmune disease. So they had this epidemiologist

00:07:37.720 | from the London School of Tropical Medicine and Hygiene, Dr. David Straughan, and they asked him to do a

00:07:43.420 | study to figure out why they were seeing so much, they call it hay fever, but essentially asthma and

00:07:48.600 | eczema. And he did a 21-year study. He looked at 18,000 kids from birth to age 21. The first discovery

00:07:57.020 | was that kids who lived in large households with extended family, cousins, lots of other kids who

00:08:03.600 | were getting sick all the time, like your cousin sneezed on you and now you're sick or, you know,

00:08:08.580 | somebody gave you a virus. Those kids, they had much lower rates of autoimmune disease when they

00:08:14.620 | grew up. The immune system was being trained by these frequent illnesses. So that was the first

00:08:19.360 | surprising thing. The second surprising thing was that kids who were more affluent, who lived in houses

00:08:26.100 | with better access to showers and things like that, who were cleaner essentially, who were bathing all the

00:08:30.760 | time, those kids had much higher rates of autoimmune diseases as adults. So what the hygiene hypothesis

00:08:36.620 | told us, and it took us till the 1980s to figure this out from his study, is that exposure to childhood

00:08:42.780 | germs is important for creating a balanced immune response later on. That's not going to freak out

00:08:48.280 | and develop an autoimmune disease. And number two, that being super cleaned, being super sanitized

00:08:55.560 | is not good. It can also create a problem with the immune system. And the really interesting thing is

00:09:02.340 | that if we look at a map of the world today, we see high rates of autoimmune disease in the more

00:09:06.980 | developed countries like the U.S. and Canada and Western Europe and Australia. And we see really low

00:09:13.420 | rates in sub-Saharan Africa and India and Southeast Asia. But as countries become more industrialized,

00:09:20.120 | as they get super clean and also eat more processed food, more medicines, etc., you start to see the rates

00:09:26.680 | of autoimmune disease rising. So we're seeing, for example, increasing rates of autoimmune diseases in

00:09:31.920 | India, in parts of the Middle East. And that it's due to a lot of things, but part of it, a huge part

00:09:38.480 | of it is this sort of super sanitation and people getting very clean and also sort of cleansing their

00:09:45.000 | bodies with all these personal care products and cleansing their homes with things that are removing a lot of the

00:09:50.560 | healthy microbes.

00:09:51.240 | Okay, so I have a thousand questions, but I want to take a quick pause because we have two young kids at

00:09:57.060 | home. And I would say, you know, culturally in the States with young kids, it's like sanitize their hands

00:10:02.920 | all the time. They're always touching gross stuff. Just the other day, my daughter, you know, was in the

00:10:08.920 | bathroom dancing and fell on the floor and then just started rolling around in a public bathroom on the

00:10:13.360 | floor. You know, very rarely does it seem like kids are using public, even public water fountains.

00:10:19.600 | They're all bringing water bottles. You know, where's the balance, right? I assume that if

00:10:24.380 | someone's rolling around on the floor of the bathroom, they should probably wash their hands,

00:10:27.960 | but maybe you don't need to sanitize their hands 15 times a day. And maybe they don't need to shower,

00:10:32.640 | you know, once or twice every single day. How do you strike that balance?

00:10:36.320 | Yeah, it's such an important balance. Generally now, I see these kids with a hand sanitizer hanging off

00:10:42.920 | their backpack and I'm like, oh no. First of all, there are things in some of these hand sanitizers,

00:10:48.240 | triclosan and other things that are endocrine disrupting chemicals. So I'd much rather take my

00:10:52.380 | chances with dirt than with triclosan for my kid, number one. And if you look at how young babies are,

00:11:00.180 | they put everything in their mouth. That is an instinct. That's not, oh, they're misbehaving or

00:11:05.040 | they didn't get the memo. They do that because that is how they're interacting with their environment.

00:11:10.440 | They are putting things in their mouth to get microbes into their body. And that's an important

00:11:15.200 | part of childhood. But what do we do? We take it away and we sanitize it and we put chemicals all

00:11:20.380 | over it. And we're like, now you can touch it. So getting dirty is not only good, it's essential.

00:11:26.980 | And there's a great book out there called Last Child in the Woods, Nature Deficit Disorder. I think

00:11:32.460 | it's by Richard Louvy. And, you know, we're all sort of focused on the screens and the kids are on

00:11:36.600 | computers too much of the time. And that's all true. But the bigger issue is they're not outside

00:11:41.380 | getting dirty, interacting with nature. Because after our initial journey through the birth canal,

00:11:47.800 | those of us who are lucky enough to be born vaginally, that's when we get colonized with a

00:11:52.920 | mother's good bacteria. And that forms the beginnings of our foundational microbiome.

00:11:58.200 | So after that, we then need to get those microbes from nature, from food, ideally that's grown in dirt,

00:12:05.620 | and from getting dirty ourselves, from, you know, being out there with grass and trees and all of

00:12:11.600 | it. And we see that kids who are born in the hospital via C-section, who don't get the benefit

00:12:18.100 | of coming through the birth canal, they are colonized with hospital-acquired staff instead of the mother's

00:12:24.780 | healthy bifidobacterium lactobacillus. And interestingly, Chris, for years after birth, they have higher rates

00:12:31.240 | of allergies, of asthma, of autoimmune disease, and of obesity. And if you add a kid who was born

00:12:37.760 | by C-section and then not nursed formula, you see all of those really go up.

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00:15:10.920 | Okay. So I'm still thinking I've got these two kids and I'm going to ask one more follow up. So on

00:15:18.420 | one hand, you're touching dog poop. You're in the bathroom. Got to wash your hands. On the other hand,

00:15:24.080 | like you're playing in the dirt. Don't wash your hands. How do you feel about the middle ground? You

00:15:28.800 | know, riding public buses, you know, wiping down the seats and the tray tables on an airplane. Like

00:15:35.380 | where are the kind of public places like the, you know, the railing on the subway? How do you feel about

00:15:41.680 | those? Are those good germs?

00:15:42.920 | Those are fine. They're fine. I mean, I don't know that I can make a strong case that the germs on the

00:15:49.120 | railing on the subway are good for your child. But here's the thing. Your kids have a healthy immune

00:15:53.520 | system. I'm assuming that they don't have an immune deficiency syndrome or anything like that. And

00:15:57.960 | it's training the same way that we want our kids to learn grit and resilience socially.

00:16:03.320 | It's important for them physically also. So when I see the parents hand sanitizer on the tray and all

00:16:10.060 | of that, that, I mean, I don't know what's going on with that kid. That kid could have a very serious

00:16:14.400 | immune deficiency syndrome or some other reason, but most of the time it's a terrible idea.

00:16:20.400 | It's a terrible idea because the kid is not catching Ebola from the tray. And what we have,

00:16:27.340 | what we clearly know now is that being too clean is worse than being dirty by far, by far. So the

00:16:35.500 | bathing too, like your kids, um, you know, let them get dirty. It's great. Like a dog is a lot of work.

00:16:41.800 | So I'm not advocating for a dog if you don't have one, but there's studies that show that households

00:16:45.920 | with children who have dogs, the kids end up on fewer antibiotics. They have fewer autoimmune diseases

00:16:51.580 | because a dog is bringing some dirt and some outdoors into your house.

00:16:55.320 | So to circle back to the gut, we talked about a lot of the benefits of a healthy gut. How does someone

00:17:01.340 | even know if they have a healthy gut?

00:17:03.000 | There are some really important feedback loops in the body and the gut has a lot of them. So for example,

00:17:10.500 | I talked about reflux earlier on, if you are having heartburn, it is not because you're overproducing

00:17:16.880 | acid. That doesn't happen. Overproduction of acid is a very rare disorder called Zollinger-Ellison

00:17:21.520 | syndrome that occurs in about one in a million people, which means that maybe 380 people in the US have

00:17:27.540 | overproduction of acid for the other, you know, many millions who have heartburn. It's because they're

00:17:32.780 | having inappropriate opening of that lower esophageal sphincter. Why is it opening inappropriately?

00:17:37.820 | Eating too late at night, eating too much food, too much caffeine, too much alcohol. So overfilling

00:17:44.260 | the stomach causes a valve to pop open and things like caffeine and alcohol, nicotine also can make

00:17:50.960 | that valve open. But what do we do? We go out and we take these acid blockers instead of paying

00:17:55.940 | attention to that. When you have reflux, it's not because your body is not working. Your body is giving

00:18:02.100 | you really important feedback and saying, hey, that eight o'clock meal that you're having every night

00:18:07.040 | and then you're lying on the couch, not a great idea. Or that extra cup of coffee or the second

00:18:12.560 | glass of wine or whatever it is. So that's an important part of feedback higher up. Constipation

00:18:18.260 | is also really important feedback. Constipation on its own isn't a disease, it's a symptom. And it's a

00:18:24.160 | symptom that either you're not putting in the right output to get the desired output, you're not hydrating

00:18:31.180 | enough. So things are kind of getting stuck along the way. Maybe you're taking a medication that's

00:18:35.800 | slowing down your gut motility. Maybe your gut microbiome is off. Maybe you need more core

00:18:41.480 | ab strength to really help push things along. Often it is a medicine cabinet. And so when somebody comes

00:18:47.480 | to see me with something like bloating and constipation, which are really common GI symptoms,

00:18:52.200 | irregularity, the first place I go is a medicine cabinet. Because, for example, a lot of vitamins can cause

00:19:00.300 | gut distress. They can slow down gut motility. Anything containing iron in it is going to slow

00:19:05.560 | down. Your gut motility can make you constipated. Calcium-containing supplements, et cetera, can also

00:19:11.660 | do that. Prescription medications, pain medications, of course, can slow down the gut. But even medications

00:19:17.380 | you might not think about, like antidepressants, anti-anxiety medications, those often cause bloating

00:19:22.100 | and constipation. There are medications that people are on for high blood pressure that do it. So the list is

00:19:27.640 | really long. And we're just talking about causing constipation. If we look at now messing up the gut

00:19:33.580 | microbiome, there was a study that was published in the journal Nature, and they looked at 41 different

00:19:39.400 | medications, and they found that half of them were causing problems in the gut microbiome, including

00:19:45.300 | things like laxatives that, you know, you think, okay, I have a slow gut. I'm going to take a laxative. You

00:19:50.860 | don't think the laxative is actually messing up your microbiome. Artificial sweeteners, anti-anxiety

00:19:56.340 | drugs like Prozac. So the list is really long. So the medicine cabinet is one of the first places I go.

00:20:01.760 | And then you have to think about, okay, hormonally, is there something going on? Is my thyroid underactive?

00:20:07.900 | And that's why my gut motility is slow. So it's always a good idea. Check your thyroid function.

00:20:12.460 | If you are suddenly finding you're more constipated, things are slowed down. So could it be something

00:20:18.060 | hormonal like that? Could you be in perimenopause? Probably not you, Chris, but I certainly could.

00:20:24.260 | So, you know, is there a change in your internal hormonal milieu that's causing your gut to behave

00:20:30.700 | differently? So is it something hormonal? Is it something physiological? Do you have a mass,

00:20:36.540 | a tumor or something that's pressing on your gut? Or it could be something more benign, like a uterine

00:20:40.820 | fibroid. So really important to play medical detective. I'm not saying don't go to the doctor and don't take a

00:20:46.420 | drug, but figure out what's causing it rather than I'm just going to take this, this thing. And my

00:20:52.880 | second book, no, my third book is called, uh, the bloat cure 101 things. And each one is a page and

00:21:01.160 | it's a disease. So a is like air aphasia, air swallowing that could be causing it, you know,

00:21:06.120 | and it goes through all these different causes from food intolerances to hormonal things,

00:21:11.440 | to anatomical things, voluptuous venous colon being one of mine. Women have a twistier colon,

00:21:16.760 | but it's so important for people to literally like roll up their sleeves and be medical detective

00:21:22.260 | because unfortunately, Chris, the reality is that the medical community just does not have the time

00:21:28.420 | for that. That is not the way we are oriented to practice medicine in 2025. It's like, okay,

00:21:34.460 | this is wrong here. Take this. It's not like, okay, let's talk about how much water you're drinking,

00:21:39.320 | how much fiber you're having in your diet. Are you moving your body? Are you taking an iron

00:21:43.020 | supplement that's slowing you down? So my goal is I want to put the tools in people's hands. So,

00:21:48.160 | you know, read the bloat cure if you're bloated and in those 101 pages, hopefully you'll find what's

00:21:54.580 | bloating you or my first book gut bliss, which sort of explains all these different things going on in

00:21:59.280 | the GI tract. And so again, very clear. I'm not saying don't go see a doctor, but I think it's so

00:22:05.780 | important for people to understand how their GI tract works. What are the things that are basically

00:22:11.840 | making it behave badly, go wrong, and how can they fix it?

00:22:16.040 | Let's say you don't have any of that. Like you're not bloating right now. You're not constipated.

00:22:19.720 | Everything seems to be working. Is there still opportunity to improve your gut? And is there a

00:22:26.620 | way to diagnose whether you're like, you know, on the brink of things going wrong or you're really,

00:22:31.620 | you know, you're, you're an A plus. I do also want to mention in addition to GI symptoms. So

00:22:36.820 | the reflux, the burping, the bloating, the constipation, loose stool, um, irregular bowels,

00:22:42.240 | it's also your immune system. Cause we talked about that close connection. And when I mentioned that,

00:22:46.960 | you know, the gut lining is only one cell thick, you have all the trillions of microbes on one side

00:22:53.020 | of the gut. And then you have the immune system on the other, you have all those cells that are

00:22:57.480 | releasing the cytokines, et cetera, on the other, and they're in constant communication. So when we

00:23:02.160 | see that the gut microbiome, for example, is disrupted, because let's say you took a massive

00:23:07.820 | course of antibiotics and you've wiped out a lot of your gut bacteria, or you've been eating a crummy

00:23:11.980 | diet for years with not enough fiber and too much processed food, and your microbiome is a bit off.

00:23:16.400 | That is potentially going to affect your immune system. Maybe it's an autoimmune disease.

00:23:21.980 | Maybe it is, you're getting sick frequently, you're having lots of coughs and colds. And so that's an

00:23:28.020 | important clue also, that something could be up with the gut. And it doesn't mean not everybody who

00:23:33.400 | has an autoimmune disease has an unhealthy gut, but autoimmune diseases are often born in the gut.

00:23:39.920 | Frequently, there's a genetic predisposition, but there is some kind of trigger, and the trigger is

00:23:46.220 | often happening in the gut. So that's an important consideration too. If you, or if you have a kid who's

00:23:51.160 | sick all the time to think about what's going on in the gut, I really don't advocate for a lot of gut

00:23:57.600 | testing because it's kind of like whole genome testing. So in the 35 years or 40 years since we've

00:24:05.300 | been able to sequence the entire human genome, an incredible project, the Human Genome Project,

00:24:10.540 | that took multiple institutions globally, billions of dollars, were able to sequence the entire human

00:24:18.280 | genome. And how many genetic diseases do you think we've been able to cure since we've been able to

00:24:23.260 | sequence the entire human genome?

00:24:24.720 | I'm going to at least assume one, but I feel like your answer is going to be zero.

00:24:28.880 | It's a big donut because the genes are just a part of it. So it's the same thing. And just to sort of

00:24:35.600 | define the microbiome a little bit for people who may be a little less familiar, we're talking about all

00:24:41.260 | the organisms that live in and on our body, mostly in our gut, but they're also on our skin, on our scalp.

00:24:47.100 | They're even in our lungs. They're in our bladder. They're everywhere. They're under our nails.

00:24:51.160 | And we're talking about bacteria, but also viruses, parasites, fungal organisms, archaea.

00:24:57.540 | So multiple different organisms. We can't see them, but if we scraped them all up, the ones in our gut,

00:25:03.620 | they'd weigh about three to four pounds. It's over a hundred trillion. We have somewhere around two to

00:25:09.280 | three times as many microbial cells as we have human cells. So we're sort of more microbe than human when

00:25:17.000 | you think about it. We're like the beehive kind of inanimate. And then the microbes are all the bees.

00:25:22.280 | So we're talking, and then all the genetic materials, a big density of stuff. And what do

00:25:28.800 | they do? Well, they digest food. They help to synthesize vitamins like vitamin K. They help to

00:25:34.660 | neutralize toxins. They train the immune system, the whole hygiene hypothesis we were talking about,

00:25:39.460 | and they turn genes on and off. So Chris, you could have a genetic predisposition for a disease,

00:25:45.360 | but because of the complement of your microbiome, you don't develop the disease because the microbiome

00:25:51.060 | can inactivate those genes. So you could have an identical twin, identical genetic material,

00:25:56.640 | and you have a disease and they don't, or vice versa, because your gut microbiome is influencing

00:26:03.320 | disease expression. So you would think with all of that, like, all right, bring on the microbiome

00:26:08.920 | testing. Let's figure out what's going on. No. And that's because we are, this is in its infancy.

00:26:15.700 | So we've identified maybe a thousand or more, a few thousand species in the gut, but they're probably

00:26:22.000 | hundreds of thousands. And then just identifying the species isn't enough. We have to understand

00:26:27.420 | the metabolites and what they do. And sometimes bacteria can go from making one thing to making

00:26:32.600 | something else as an adaptive response based on a change in the environment. So it's really premature

00:26:38.860 | to go and get a microbiome, a stool microbiome test and think that, oh, it's going to tell you

00:26:45.880 | everything you need to know. What I do recommend to people is to be citizen scientists, to contribute to

00:26:52.060 | the research through organizations like the American Gut Project, which is a nonprofit. For less than a hundred

00:26:57.100 | bucks, you can send your stool in. They'll do an analysis. They're not going to then try and sell

00:27:01.360 | you a bunch of supplements or tell you, you know, you can't eat blackberries. So a lot of the commercial

00:27:06.140 | testing, it gives recommendations that I think are really misleading and erroneous. And then there's a

00:27:13.040 | whole upsell of like, take this product and it's going to fix your microbiome. So I think if people want

00:27:19.840 | to do it because it's interesting, contribute to the science. So the American Gut Project, their database

00:27:24.100 | is open to researchers all over the world. And so for example, somebody studying Parkinson's disease

00:27:30.400 | can look at stool samples and the microbiome of people with Parkinson's disease to figure out that

00:27:36.180 | actually Parkinson's begins in the gut, believe it or not. They published data about six years ago,

00:27:42.900 | the American Gut Project study. And that was the largest microbiome study done ever. It was over

00:27:49.580 | 10,000 people, over 40 different countries asking the question, what makes a healthy microbiome?

00:27:55.640 | And the answer was, drum roll, people who ate 30 or more different plants per week had the healthiest

00:28:06.200 | gut microbiome. You didn't have to be vegan or even vegetarian. They were vegans with really unhealthy

00:28:11.200 | microbiomes, vegans who were eating typically less than 10 different plants per week. And they were

00:28:17.080 | straight up omnivores, but who were eating a wide variety of plant matter. And so that's not just

00:28:23.100 | vegetables, it's fruits, vegetables, whole grains, nuts, beans, seeds, herbs, spices, all of it. So

00:28:29.840 | basically having a varied diet. And it's the same kind of stuff that Dan Buettner found with Blue Zones,

00:28:35.940 | right? Is having a wide variety of different plants in your diet is really where it's at.

00:28:42.020 | Okay. And so I know there are these tests. I think Jonah, Tiny Health are a couple of them. I'm looking

00:28:48.240 | at a couple of these websites because I want to understand. And I've had friends that have taken

00:28:51.640 | them and it's like, oh, like you're going to learn how healthy your gut is and what supplements you need.

00:28:58.820 | As someone who studied this a lot, are you kind of like, there's just not enough evidence to support

00:29:03.900 | what you would do? So maybe it's more like 23andMe where you can learn about all the bacteria, but

00:29:08.960 | like, what do you do with that? Or is there a person for whom these tests are really interesting

00:29:15.580 | or are they really just, you know, wrapping away to sell more supplements?

00:29:20.280 | The latter. I try to direct people away from the commercial microbiome companies where the whole

00:29:25.680 | goal is kind of what you said, an upsell of supplements and things that are just sort of

00:29:30.500 | nonsensical. And the problem too, is that it kind of takes people's focus away from what they actually

00:29:37.160 | can do, which is overuse of antibiotics and acid blockers is a huge threat to the microbiome.

00:29:43.340 | A diet without enough fiber, huge threat, too much alcohol, processed foods, all the things that you

00:29:48.860 | would imagine. But when somebody gets this result and they're like, oh, you just have to take the

00:29:53.980 | supplement. It makes them think like, oh, I don't have to do these other things. You know, I just take

00:29:59.300 | this pill. And so that I think is really, that's problematic.

00:30:05.080 | Yeah. I have not done one. I'm like curious as a curious person, but it just reminds me of 23andMe

00:30:12.820 | where it was like, you likely have blue eyes. And I was like, well, I knew that one. You know,

00:30:17.740 | here's your earwax type. It was like kind of fun things, but it was more fun than I didn't change

00:30:23.240 | anything about my life because of it. Yeah. And we see what, what, what's, you know,

00:30:28.420 | that company's going through. Right. And so a lot of this, I mean, I think a lot of these folks,

00:30:33.740 | some of the microbiome testing companies were started by really good researchers and I think

00:30:37.800 | they start out well-intentioned, but that there's always that line, right? Like, you know, oh, if we

00:30:43.080 | say this and we do this and because they're marketing something, you know, they're not there as healthcare

00:30:49.040 | providers. They're there to sell a product. And so there's almost always some over-promising and

00:30:56.500 | under-delivering on that end. But again, I do encourage, especially people, whether you're healthy,

00:31:01.900 | you look like you would have really good poo and a good microbiome or for somebody who has an autoimmune

00:31:08.260 | disease and wants to see, or wants to get it checked and then is planning on making some intervention,

00:31:14.260 | it can be helpful, but it's not predictive. So you can make a ton of changes and you may not see any

00:31:20.840 | significant changes in your microbiome. And you could make no changes in your diet and your microbiome

00:31:26.520 | could still shift because there are other things that are informing it. Our environment,

00:31:30.960 | our exposures, the stress in our life, all of this stuff affects the microbiome.

00:31:36.040 | I think there are some foods that everyone knows, like it's probably better to not eat all, you know,

00:31:40.000 | processed food and it's good to eat whole foods. Are there any things that are surprising,

00:31:45.360 | controversial, or more in the middle where people, it's not so definitive that are things people should

00:31:50.400 | be either thinking about or testing on themselves to see how their body reacts to certain foods?

00:31:56.820 | I'm going to make a lot of people really unhappy right now by saying that kombucha

00:32:02.140 | does not improve the health of your gut microbiome. We have no convincing evidence. However,

00:32:08.680 | this is important. If you are swapping out soda or alcohol for kombucha, that's a win,

00:32:15.400 | right? Because we know that soda, any amount is terrible for the gut. And we know that alcohol

00:32:20.800 | is bactericidal. It kills bacteria. It doesn't mean that it's terrible depending on how much you're

00:32:25.880 | drinking, but alcohol is a killer of gut bacteria. So if you're trying to drink less and you're like,

00:32:31.160 | hmm, I'm going to swap, you know, a couple beers I have at night or my usual cocktail for kombucha,

00:32:38.160 | great. But the idea that you're going to drink the kombucha and it's sort of regenerating your gut

00:32:43.320 | microbiome, no. One of the most effective foods beyond the general, like you want to eat food that

00:32:50.260 | didn't come from a factory, right? Ideally, is fermented foods. Unbelievable. And the Sonnenbergs at

00:32:57.860 | Stanford, a husband and wife couple have done a lot of great work on this. So a fermented food like

00:33:03.340 | sauerkraut is a triple threat in a good way. It's prebiotics, meaning it's a food that the bacteria

00:33:12.260 | eat because it contains fiber. If we look at something like sauerkraut, it's cabbage, right? So

00:33:15.920 | it has prebiotic foods in it, the actual cabbage. It has probiotics, live bacteria, because in the

00:33:22.260 | fermentation process, you're generating lactobacillus. And it has postbiotics, which are

00:33:27.800 | things like short chain fatty acids that are all the compounds that are being made by the bacteria as

00:33:32.660 | they're fermented. So a jar of like really good quality sauerkraut, not like a pasteurized, you

00:33:38.540 | know, factory made one, but like, let's say you get something from the farmer's market or that is one of

00:33:44.520 | the most medicinal foods you can eat. And I'm very skeptical, like the whole, you know, acai berry and

00:33:50.140 | like, yeah, the whole superfood thing is so overdone. But there is such great scientific

00:33:54.820 | evidence for something like sauerkraut or even fermented vegetables. I have in my second book,

00:34:04.200 | the microbiome solution, which is actually my favorite. I have some great recipes in there.

00:34:09.980 | And we borrowed some recipes from Jeff Cox's great book, The Essential Book of Fermentation

00:34:14.180 | for the fermented food recipes. They're delicious. Like there's an apple and cabbage

00:34:21.480 | sauerkraut in there. That's fantastic. Fermenting stuff is pretty simple. You need a mason jar,

00:34:26.760 | you need water and salt. And you can ferment almost any vegetable, or you can do what I do and go to the

00:34:34.700 | farmer's market and buy some from somebody who's done it. But it's incredible. And you only need like

00:34:40.120 | a tablespoon. So even if you don't like sauerkraut, if you can commit to like a tablespoon of sauerkraut

00:34:47.220 | or kimchi, incredible. Yeah, you were saying sauerkraut the whole time. And I was like,

00:34:51.080 | I don't love sauerkraut, but I love kimchi. And do the kids, will the kids eat it? Because so good for

00:34:55.760 | them. TBD. Kids don't like spicy, but they don't mind fermented. And we went to Vietnamese restaurant

00:35:02.960 | yesterday and the kids usually eat whatever we order as long as it's not too spicy. Wonderful.

00:35:08.000 | So we have not crossed the spice hurdle, but everything else seems to work.

00:35:12.020 | Yeah, the kids menu is ruinous to children's guts. So if you can, if you can do that, I encourage your

00:35:18.060 | kids to just have a little taste of what you're having rather than the, you know, the chicken tenders

00:35:21.840 | and the tater tots and the mac and cheese. That's fantastic. Full credit to my wife who had the kind

00:35:27.000 | of like 100 foods in 100 days plan, where when our daughters first started eating solid foods,

00:35:33.600 | there was a goal that in the first 100 days, we wanted to expose them to 100 different foods.

00:35:37.380 | And these are like raw ingredients, not like a Twinkie, an Oreo, that kind of thing, like a vegetable,

00:35:43.260 | a fish or, you know, a legume or something. And I was surprised by the time you get to 100,

00:35:48.020 | you're kind of going out there. We weren't necessarily counting every single fish in the

00:35:52.060 | sea. But even then, that's, you know, that's not going to get you to 100. So it was like every

00:35:56.140 | vegetable, every fruit, we'd go to some of the kind of markets from other countries to try to

00:36:01.520 | find fruits and vegetables that we don't normally get. And I, it was awesome. And I think now there

00:36:06.800 | are things our kids don't like, but you know, they'll always try something. So we've, we've tried

00:36:12.600 | hard to expose our kids to a ton of food. And so far it's been successful, except spice.

00:36:18.060 | I love that your, your wife was actually basically following that American Gut Project data of 30

00:36:24.600 | different plant foods per week, even the bonus version of that with a hundred without knowing

00:36:29.740 | that data, but just inherently was like, it's good for my kid to eat a wide variety of foods.

00:36:34.360 | It's incredible. Yeah. We just wanted them to try everything. Now the downside is the more we expose

00:36:38.720 | them, sometimes they have really expensive palates. Like we went out to dinner with my parents once and

00:36:44.400 | my dad loves sashimi. We all do. And he orders this sashimi plate. My daughter's like just grabbing

00:36:48.960 | it by the piece, eating it like popcorn. And we're like, man, you are an expensive, uh, dinner companion.

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00:39:19.560 | find the link in the description. You did mention when you were talking about sauerkraut pre and

00:39:24.440 | probiotics. I feel like it is a topic I know absolutely nothing about, but I know there are,

00:39:30.600 | you know, friends and family members who are like, Oh, are you taking your prebiotics and probiotics

00:39:34.200 | every day? Like, this is what I take. Where, how do you, clearly the gut is probably the target

00:39:39.880 | of why they're taking those things. Yeah. How does that fit in, in your kind of framework?

00:39:45.160 | Well, the first thing I want to tell people is that prebiotics are food.

00:39:49.080 | That's what you should think. A prebiotic is not a pill or a supplement. The World Health

00:39:54.280 | Organization definition, a probiotic is a live organism that when ingested confers a benefit

00:40:02.600 | to the host. So that knocks out 99% of the things people are taking because they're conferring no benefit

00:40:08.440 | to them. They're, they're taking some pill from the supermarket or the pharmacy and it's supposed to

00:40:16.120 | have this amount of live bacteria. Maybe it does, maybe it doesn't. And they're just pooing it out,

00:40:21.000 | mostly dead bacteria, not present in sufficient quantities to colonize the gut and reproduce and

00:40:27.880 | make a difference and not clear that these species are necessary or doing anything. So the most important

00:40:34.280 | part for people to know is that you need to be trying to colonize in, in terms of encouraging

00:40:40.840 | reproduction of your existing bacteria because half the stuff you're taking in a pill is dead or not

00:40:47.640 | helpful. There are some probiotics out there on the market, one in particular that I use in my patients

00:40:52.360 | because it's been studied in over a hundred human trials. And it's a combination of seven or eight

00:40:57.960 | different strains of bacteria that have been very well studied for serious conditions like ulcerative

00:41:03.320 | colitis, as well as irritable bowel syndrome and found to have efficacy. But that is the kind that

00:41:09.400 | is refrigerated. It is sent to you with a little monitor to show that it maintained this temperature.

00:41:15.080 | If the temperature went above this amount, there's not enough viable organisms and they'll, they'll replace

00:41:20.760 | it. That's not the typical over the counter that people are just going to the health food store and

00:41:26.360 | buying. And even for that one, as sort of fancy and spectacular as it is, I use that primarily in

00:41:32.680 | my patients with gut disorders. I don't recommend that the average person take that like vitamins.

00:41:37.240 | We don't have any evidence that the average person benefits from taking a multivitamin.

00:41:40.680 | Now, if you have Crohn's disease and you'll be 12 deficient, sure. Or if you have vitamin D deficiency,

00:41:45.800 | or if you're iron deficient, but just then you take iron, but just taking a multivitamin,

00:41:50.680 | then we don't have evidence that it's doing anything. So a much more meaningful and impactful

00:41:58.360 | approach is to think about the gut bacteria in your gut already. You've got trillions of them.

00:42:02.840 | And what can you do to feed them and to amplify them and to feed the right species? And this is where

00:42:08.120 | you get into, okay, we want to feed them more fiber. We want to cut down on the alcohol and the processed

00:42:13.160 | food. We want to make sure we're hydrating so that our gut is moving. Our gut motility is normal,

00:42:18.360 | because when the gut is stagnant, that also creates problems with the gut bacteria.

00:42:21.960 | It is not as sexy, perhaps, as taking a pill, but is much more impactful for your gut. So that's a

00:42:30.120 | probiotic. Prebiotics refer to the food that bacteria eat. The food, not the pill or the powder or the

00:42:37.720 | potion, the food, the actual fiber. So things like legumes and greens and, you know, berries and all those foods

00:42:46.120 | that contain fiber. But particularly when we think about things like, um, foods that are high in

00:42:51.400 | inulin. So it could be things like dandelion greens and oats and so on. And the fibrous part of the

00:42:56.120 | vegetable. So if you think about like the broccoli stock, that's where most of the fiber is. It's not

00:43:01.080 | in the floret or vegetables like celery. So think of those dense, fibrous foods. Those are prebiotics.

00:43:08.680 | You're feeding your gut bacteria. We don't have evidence that a prebiotic pill or powder is doing

00:43:15.080 | anything. And that's why I always tell people, as Maya Angelou famously said, when somebody tells you who

00:43:20.120 | they are, believe them. When you see the label at the bottom saying this compound has not been shown

00:43:25.960 | to treat or cure or fix anything that's wrong with you, believe it. They are telling you this is not

00:43:32.440 | doing anything and people are still buying it. I don't get it.

00:43:35.400 | You mentioned hydration. How much water do we need in a day for healthy guts?

00:43:42.280 | There's pretty significant variation based on your activity level, how much water you're getting from

00:43:48.200 | the food you're eating, etc. But a good rule of thumb, Chris, is half your body weight in ounces

00:43:53.880 | of water. So if you weigh 150 pounds, 75 ounces. If you weigh 200 pounds, 100 ounces as a baseline of just

00:44:00.280 | water. Not water with salt or minerals or anything in it. Just basic water. That's a really good rule

00:44:06.360 | of thumb. You said plants are good. What about animal products like meats and dairy, cheeses, milk? Any of

00:44:14.440 | those good, bad for your gut or moderation? From a GI point of view, there's room for a little animal

00:44:22.600 | protein on the plate. I've treated thousands of patients over more than three decades. And I will

00:44:28.680 | tell you, even my patients who have severe complex autoimmune disorders where their gut is super

00:44:33.720 | inflamed, they can manage some animal protein. So there are lots of reasons to not eat animals for

00:44:38.840 | the environment, etc., etc. But to say that the ideal diet from a gut point of view completely excludes

00:44:45.960 | animal protein, I don't think that's certainly not correct in my experience. That being said,

00:44:52.280 | I will tell you that for a lot of my patients with severe inflammation in their gut, increasing the

00:44:57.080 | amount of plants they're eating is incredible. So usually what I'll say to people is, if you want

00:45:02.040 | to eat some animal protein, have one animal protein meal a day. It could be breakfast, lunch or dinner,

00:45:06.360 | where the meal is built around animal protein. And then for the rest, try and build it more around

00:45:11.000 | plants, including foods that are high in plant protein, like legumes, etc. But to not have every

00:45:17.560 | meal be so animal protein centric, because then you tend to crowd out the plants. So I think that's a

00:45:23.480 | pretty reasonable way to do it. And you know, Chris, we talked about feedback, your body gives

00:45:27.480 | you that feedback. Because most people who go on like a serious high protein keto type diet,

00:45:32.520 | what's the first thing that happens? They get constipated, right? We saw sales of psyllium husk

00:45:39.480 | that most people would know as Metamucil soar with the advent of the South Beach diet and the Atkins diet,

00:45:45.880 | etc. Because everybody was so constipated. Animal protein is fine, depending on your requirements for based

00:45:52.680 | on what you're doing and your daily activities, you can you can tolerate and you can probably tolerate

00:45:57.240 | more than the one meal a day. But once you start to get constipated, that's generally a sign that you know

00:46:03.240 | that you need to cut back on the animal protein and add in some more plant, more plant fiber.

00:46:07.560 | Are there any other kind of sneaky things that play a negative or positive role? I know,

00:46:12.600 | I think I've seen you talk a little about artificial sweetener. And how does that fit in? And are there

00:46:18.360 | any other similar things that it's that can have a really big impact? Artificial sweeteners are really

00:46:22.840 | problematic. And the worrisome thing is they've kind of snuck into everything, right? So people advertise

00:46:27.560 | like low sugar. And you think, okay, this has less sugar. But what they mean is, it's got artificial

00:46:33.480 | sweetener in it. And we know definitively that these non-nutritive sweeteners, as we call them, the sucrose,

00:46:41.240 | the maltose, all the different oses, which are poorly absorbed sugars, that they really wreak havoc

00:46:47.400 | on the gut. The reason they don't contribute calories is because they're not absorbed in the

00:46:50.840 | small intestine. So they float on down to the colon, where they get fermented by gut bacteria, but they get

00:46:56.440 | fermented into harmful post-metabolic products, not healthy things like short-chain fatty acids.

00:47:03.720 | And some of that too, they'll give you gas. If you've ever had like diabetic candy with a lot

00:47:07.640 | of artificial sweetener, one of the first things you'll see is like, oh, I'm having terrible bloating

00:47:12.440 | and gas. And that's the products of fermentation. The other thing I want to tell people, particularly

00:47:17.720 | people who might be struggling with their weight and thinking, I'll have a low calorie sweetener since

00:47:23.240 | I don't want to have the calories, is that insulin, the hormone that will sort of signal your body that

00:47:29.720 | things should be stored as fat. Insulin is released in response to sweetness, not in response to

00:47:35.720 | calories. So even if something says zero calories or 10 calories, and you burn it in a calorometer,

00:47:42.120 | and it's low-cal, when you ingest that substance, and if you've ever had something sweetened with an

00:47:47.480 | artificial sweetener, you know artificial sweeteners are typically very sweet, usually sweeter than regular

00:47:53.080 | sugar. So you ingest that, you get the same or more insulin release, which is why diet sodas

00:48:00.760 | are just as big a likelihood of you gaining weight as regular soda, and sometimes more,

00:48:07.880 | because sometimes the insulin releases more. So it's pretty misleading for consumers. They say,

00:48:12.040 | oh, zero calories. And that may be true, but not zero weight gain. You're still getting the weight

00:48:17.240 | gain because you're getting the insulin release. And so I really try and stare people away from any sort

00:48:23.240 | of diet, anything, non-nutritive sweeteners, because of that, but also because they're really tough on the

00:48:29.960 | gut and particularly disruptive to the gut microbiome. So one way to get around that is to,

00:48:35.000 | I always say have the regular sugar, but just have less of it. If you usually put a tablespoon of sugar

00:48:40.280 | in your coffee, try a teaspoon or half a teaspoon. So just gradually train your palate to have a little

00:48:46.600 | less of the sweetener. In terms of dairy, part of the problem with the dairy is that the dairy industry

00:48:52.760 | in this country is full of antibiotics. Typically, the dairy cows are being given antibiotics

00:48:57.960 | prophylactically to prevent other infections, etc. And it becomes then sort of a highly processed

00:49:05.320 | product at the end. That's often the animals have been exposed to antibiotics. But if we look at

00:49:10.600 | something like cheeses, like a good quality cheese, cheese is a fermented product. And if you're in

00:49:15.880 | France and where you can eat a different cheese every day of the week and never have the same cheese twice,

00:49:20.760 | and you can get like a really great, you know, locally made cheese, have some cheese.

00:49:26.440 | And if you're not terribly lactose intolerant, and you really like cheese, it's okay to have a little

00:49:31.800 | cheese, have a good quality, like a hard Parmesan, like a Parmigiano Reggio or something like that.

00:49:37.320 | Don't have a processed cheese.

00:49:39.160 | And is milk in the same bucket?

00:49:41.240 | For most people who are lactose intolerant can tolerate a little hard cheese, but they're not

00:49:45.320 | going to tolerate milk. And there's not much reason for an adult to drink milk. Because, again, milk is

00:49:51.880 | what allows a little small calf to grow into a big, huge dairy cow really quickly. So, I mean, if you're

00:49:58.920 | trying to put weight on quickly, you know, milk has a lot of sugar in it, etc. That could be something

00:50:05.880 | reasonable. But milk is a health food, not so much. It's very calorie dense, has a lot of sugar in it,

00:50:11.880 | and isn't really contributing much in terms of calcium and so on. What we find is that eating

00:50:19.080 | green leafy vegetables and small bone fish like salmon and sardine is more useful than having dairy

00:50:24.600 | for growing strong bones.

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00:51:21.160 | I have one more topic that I was surprised didn't come up earlier. When we were talking about

00:51:25.320 | the symptoms, you know, you went through the symptoms of reflux, the symptoms of bloating.

00:51:29.720 | We're pretty far in this conversation. We haven't talked a lot about poop. It's not not a common topic

00:51:34.760 | on the show, but you mentioned a couple of times like, oh, you want to make sure you have healthy

00:51:39.480 | poop. I don't think most people know what that is. So maybe we can do a quick rapid round and run through

00:51:46.840 | what people should be knowing and thinking and doing about their poop.

00:51:49.480 | Fantastic. Before we do that, I asked Mel Robbins this when I was on her podcast last year.

00:51:56.520 | I asked Dan Harris this when I was on his podcast a few weeks ago. And I'm going to ask you,

00:52:00.760 | tell us about your bowel movements, Chris. I'll tell you, Dan got super uncomfortable.

00:52:05.080 | He turned bright red. But I think you can tell us. Are you like an everyday kind of guy? Morning?

00:52:10.200 | I am not as consistent in that. Like, I don't have a time where it's like, oh, it's like an hour after

00:52:16.120 | breakfast. That's the time. But I would say definitely feels like an everyday kind of thing,

00:52:21.480 | but not a three times a day kind of thing. It wouldn't feel alarming to me if a day went by

00:52:26.360 | without a bowel movement. Like, I wouldn't be like, oh my gosh, what's wrong? But mostly because

00:52:30.520 | I think it's, it's not so regimented in time that I don't even know if I would notice.

00:52:34.760 | And is there some ease associated with it?

00:52:37.480 | It's a much quicker thing. Like I know some people love to just go and, you know,

00:52:40.840 | sit and play around and, you know, check the news and read a book. I'm like in, out.

00:52:44.840 | So you have just described stool nirvana. So we eat every day. We should be pooing every day,

00:52:51.800 | but you can miss a day here and there. If you're a five times a week or a six times a week,

00:52:56.200 | that's perfectly fine. If you're a twice a day or even a three times a day, that's fine too.

00:53:01.160 | If the consistency is pretty good. One of the things you said is really key,

00:53:06.520 | which is your in and out. The worst thing is to take your phone in or a magazine or something,

00:53:11.320 | because you're training your bowels. Your bowels actually have nerve cells. We talk about the second

00:53:16.040 | brain in the gut, the enteric nervous system. And our, our gut has about seven times as many

00:53:20.600 | nerve cells as our spinal cord, not as much as our central nervous system. So it's a very well

00:53:25.240 | innervated organ and it's very sensitive to training. Think of potty training with kids,

00:53:29.800 | right? And so if you go in there with your phone or a book every time, what you're training your gut

00:53:35.960 | to do is to take your time. You're saying, oh yeah, we got all day. We're reading the news feed,

00:53:40.840 | take your time. So you never want to go in there with anything. You want to get in there,

00:53:44.600 | you want to get on the john, you want to try and push something out, or ideally you have the urge.

00:53:49.080 | You can give that a couple of tries. If nothing happens, you want to leave and then come back.

00:53:54.280 | And in terms of what the stool should look like, one of my favorite podcast episodes was mama jama

00:54:00.120 | poos. It is, if you want to know how to have a mama jama poo, this is an episode to listen to,

00:54:05.880 | including size. You want the stool to be about the size of a banana, ideally. Now it might not all be in

00:54:13.320 | one piece. It could be like, okay, here's three parts and you put it all together and it's about the size

00:54:18.040 | of a banana. And the reason that's important is not just because of elimination and how important

00:54:24.360 | that is for our body to detoxify and eliminate. It's because there's a really strong correlation

00:54:29.320 | between size of stool and colon cancer risk. And colon cancer is now the second leading cause of cancer

00:54:36.680 | deaths in women under 50 and the number one in men, in men under 50 and it's prostate higher

00:54:43.400 | up. So we're seeing this, you know, alarming increase in colon cancer in young people. And

00:54:48.440 | it's probably due to lots of stuff. I'm sure the food is contributing, but having a large bowel

00:54:54.520 | movement about the size of a banana is really protective against colon cancer because it means

00:55:01.160 | that you have sufficient fiber in your diet that you're having this really good elimination. And you

00:55:05.320 | want it to be a good chocolatey color, like not necessarily a dark chocolate, and you want it to have some

00:55:10.600 | form. It's okay if it breaks apart, but you don't want it, when it falls into the bowl, it should retain

00:55:16.840 | its form. It shouldn't then fall apart. And you know, a little on the soft side is good. It's totally normal to

00:55:22.600 | see a little flex of fibrous foods. Like if you're, you know, had a big kale salad the night before and

00:55:28.120 | you see a little bit of green, that's totally normal. If you are having diarrhea and you're

00:55:32.920 | seeing undigested food, like rice grains and stuff, that's a problem. That means that maybe you're not

00:55:39.000 | digesting the food properly. Maybe you're not absorbing it properly, or maybe the transit time

00:55:43.160 | is too fast. It could be any one of those things, but it's okay to see some vegetable matter, particularly

00:55:48.600 | if you're a, if you're a good fiber eater and position is really important. So the ideal position

00:55:55.320 | for having the stool shoot out, if you're bendy, you could actually sit back on the toilet and then put

00:56:01.000 | your feet up on the front of the toilet bowl. Because when you do that, you're adjusting the angle of the

00:56:06.360 | puborectalis muscle and you open up the angle and it really allows the stool to release. It's also the

00:56:12.440 | much better position for childbearing too. We're supposed to be squatting. We're not supposed to,

00:56:16.600 | you know, be lying on our backs, but that that's for another episode. And so when we look at countries,

00:56:21.160 | like countries, again, that are less developed, like parts of sub-Saharan Africa and Southeast Asia,

00:56:25.720 | where people still squat a lot over, you know, when, when I was in Turkey two years ago and a lot of the

00:56:32.280 | bathrooms in Istanbul, you had this sort of Western stall, but then you also had the option of a stall with

00:56:39.320 | a hole and you could squat over it. And trust me, there is an art to that, but squatting like that

00:56:46.120 | is much more efficient for getting the stool out.

00:56:48.440 | Any other tips. If people are like, I'm not, I'm not at Nirvana yet. Um, you know, you said fiber,

00:56:53.720 | you said hydration. Yeah. Well, the hydration one, I mean, you obviously want to be hydrated all

00:56:58.520 | through the day, but this one is really important. My husband and I have been married almost 25 years.

00:57:03.080 | And the other day I did this and I said to him, I was like, you know, when you drink this chug a whole

00:57:08.360 | bunch of water in the morning before you go, it really helps the stool could come out. And he got pissed.

00:57:12.440 | He was like, we've been married almost 25 years and you're just telling me that now, but keep a bottle

00:57:17.400 | of water by your bed. That's like 20 ounces and chug it in the morning, right. When you get up before

00:57:21.960 | your feet hit the ground, what that does is it triggers something called the gastrocolic reflex.

00:57:29.720 | And the gastro meaning stomach colic, meaning colon reflex is a reflex where the first thing that's in

00:57:36.200 | your stomach in the morning, it sends a chemical signal to the bottom of your digestive tract,

00:57:41.800 | your colon saying, okay, food is coming in time to empty out and the colon starts to contract.

00:57:47.000 | And that helps to give you that signal. So a lot of people find with coffee, right? And they think

00:57:52.040 | coffee helps them go and it does. But for a lot of people, it's just because coffee is the first thing

00:57:57.560 | that they're having. If they were having, you know, some water or something, the reason I recommend

00:58:03.480 | the large volume is that that will really distend your stomach. And that really helps to trigger the

00:58:08.440 | gastrocolic reflex. A sip of coffee or tea may not do it. And you don't obviously don't want

00:58:12.760 | to chug 20 ounces of coffee in the morning. I don't recommend that. But if you really fill your

00:58:18.760 | stomach with water, 20 ounces where you're like, ooh, my stomach is quite full now, you're much more

00:58:25.000 | likely to trigger that gastrocolic reflex. So if you're somebody who tends to be a bit sluggish in

00:58:29.080 | the morning with the bowel movements, and you're like, oh, I think I have to go, but I'm not sure I

00:58:33.320 | have to go, try that chugging, and then go. And you will see it will likely trigger that gastrocolic

00:58:40.440 | reflex. So the combination for stool nirvana in the morning would be, of course, the night before,

00:58:45.080 | you've had a lot of fiber that day. And then in the morning, you chug your 20 ounces of water,

00:58:50.360 | and then you get in there and you put your feet up, that can make a huge difference.

00:58:54.040 | And you said the night before, is that the general timeframe? Is it like 12 hours from eating?

00:58:59.160 | Really the day before, the transit time can be anywhere from 12 to 48 hours. So I should have said

00:59:05.800 | earlier would be better. So if you have like a huge fibrous lunch, that would be great. And a lighter

00:59:10.720 | dinner. For a lot of people who are experiencing bloating or constipation or just abdominal discomfort,

00:59:16.640 | calorie shifting where you're having a bigger breakfast and lunch and a lighter dinner will really help

00:59:21.480 | because the digestive tract functions in concert with a light dark cycle, the circadian rhythm. So

00:59:27.400 | once the sun sets, your GI tract really slows down. And so if you're having your biggest meal

00:59:32.760 | at dinnertime, you're likely to be uncomfortable, that food isn't really getting digested, maybe it's

00:59:37.720 | triggering some reflux. So ideally, your big fiber load should be a bit earlier in the day at breakfast

00:59:42.360 | and lunch.

00:59:42.840 | Okay, we talked about bloating. But what about gas either from either side? How does that fit in?

00:59:49.480 | I really like to think about gas as good gas versus bad gas. Good gas is, I had lentils and Brussels

00:59:56.440 | sprouts for dinner. And you know, now I have gas. And that is because those foods have a lot of poorly

01:00:04.960 | digestible fiber. And we don't have the enzymes. So for example, if you look at something like beans,

01:00:09.580 | there is an enzyme alpha-1 galactosidase. We don't make it. And that's because the beans,

01:00:14.820 | the fiber in the beans is really there to feed our gut bacteria. The idea is that, you know,

01:00:19.220 | we absorb what we can. The gut bacteria ferment the fiber, the poorly digestible or indigestible fiber,

01:00:25.800 | and then they make all these important things, the short-chain fatty acids, etc. So you're going to get

01:00:31.140 | some gas with that. That's different from the gas you get from, oh, I ate a bunch of sugar-free candy,

01:00:37.120 | and now I like have pain and feel terrible. Or I'm severely lactose intolerant. And that gas is

01:00:43.180 | usually accompanied by like queasiness and, you know, you just, you don't feel good. So there's a

01:00:50.480 | distinction there. And when people will say to me, well, you know, I love beans and I know they're good

01:00:55.660 | for me. When I eat them, I have gas. I usually recommend, well, eat a little bit less. Eat them

01:01:00.460 | earlier in the day. Make sure you're soaking them before you cook them. You can cook them with a sea

01:01:04.800 | vegetable like kombu. Those are all things that can help. But I would never recommend somebody

01:01:10.700 | completely stop eating beans because they have gas because you're supposed to have some gas with beans.

01:01:15.980 | And is gas actually a problem or is it more like a cultural problem?

01:01:19.160 | It's more of a cultural problem, although it can be painful, Chris. A lot of the gas that I see is

01:01:24.560 | because people are constipated. So they're not overproducing gas in their GI tract. They're just

01:01:29.280 | plugged down below. And that can happen even if somebody's having a bowel movement every day.

01:01:33.980 | They can still be constipated because what they're having is incomplete evacuation. They're going,

01:01:39.460 | but it's just a little small stool and they've still got a plug of stool there in the rectum.

01:01:43.780 | And the gas that would normally just be dissipating out where you wouldn't even feel it is now all

01:01:49.680 | plugged up in there and now they're uncomfortable. So gas is rarely a problem. I mean, I don't think in

01:01:55.160 | my 30 plus years I've ever had a medical emergency of gas. Although if somebody has a narrowing in

01:02:01.260 | their intestine, a stricture, we can see that after surgery. We can see it in people who have

01:02:05.620 | Crohn's disease. Somebody has colon cancer. You can have a buildup of gas that can be quite an urgent

01:02:10.800 | situation. But the average person, there's no gas emergency. And one of the rules of thumb is if you

01:02:17.520 | can let it out, you should. You don't want to hold it in like that. That's really not good for your GI

01:02:22.460 | track. So excuse yourself, go to the bathroom, try and let it rip. That's definitely good. And if you're

01:02:29.280 | having a lot of gas, even just all the time, not with beans or kale or things like that, think about

01:02:36.200 | whether your bowel movements could need a little enhancement. Because if you're not emptying fully,

01:02:42.320 | you may be experiencing more gas just because of that plug at the bottom that's not allowing things to

01:02:48.200 | release. And if that's not the case, is this where aerophasia, if I'm getting it right, could play a

01:02:54.120 | role here? Or for someone who's like, no, bowels are great, feel like I'm emptying lots of gas, what could

01:02:59.920 | that be? Absolutely. I'm so glad you mentioned that. Aerophasia refers to air swallowing, aero, air, and

01:03:06.560 | phasia swallowing. And it is a very underdiagnosed but common problem. And most people who are swallowing

01:03:12.660 | air are doing it inadvertently. What causes people to have aerophasia? If you have a deviated septum. Say

01:03:18.780 | your nose was broken and it didn't, you know, it didn't heal properly. If you have a deviated septum, you

01:03:24.020 | tend to be a mouth breather. Or if you have allergies. So if you have a little bit of hay fever allergies, you'll

01:03:29.320 | tend to be more of a mouth breather than a nose breather. If you're a mouth breather, you're more likely to swallow

01:03:34.640 | air. If you are talking fast, you're more likely to swallow air. If you are drinking and talking, if you are sucking on

01:03:41.880 | hard candy and chewing gum, carbonated drinks, seltzer, champagne, beer, things like that, it's normal to

01:03:48.800 | swallow a little bit of air. But if you are experiencing the triad of frequent burping, abdominal

01:03:54.960 | distension, where you're really uncomfortable, and pain like that, then you may actually have

01:04:02.460 | aerophasia. And there's some really effective techniques. Usually it's a speech pathologist who

01:04:08.860 | take care of it. Once we've done our evaluation as gastroenterologists and made sure, you know,

01:04:13.180 | it's not an ulcer or heartburn or anything like that. They'll usually evaluate people's speech and

01:04:18.020 | swallowing. And they're able to determine that they're air swallowing and sort of give them some

01:04:22.540 | training and redirect them to do whatever it is they're doing differently.

01:04:28.900 | I think both of my kids would say like, there's no cultural problem with passing gas anywhere around

01:04:35.100 | the house. And they are right. It's not beans. It's not it's not aerophasia. It's just that's just

01:04:41.040 | normal, I guess. Absolutely. There is a and kids are generally much less shy about it. Right. So you're

01:04:47.300 | going to notice it more because you're like quietly excusing yourself. And they're just letting it rip

01:04:51.120 | right there, which I love. So good. And kids, kids find it so funny. Do you kids find it funny?

01:04:56.220 | They find it hysterical. But I and I think we probably do, too. So we probably compound that

01:05:01.520 | effect. But I always wonder, like, is there an amount that is concerning? And it sounds like if

01:05:07.120 | everything else is normal. No, no. Correct. And, you know, it can be a sign of a food intolerance like

01:05:13.800 | lactose intolerance, fructose intolerance, etc. But those things usually have other symptoms like they're

01:05:18.940 | having diarrhea or they're nauseated. So if it's just gas and everything else is fine, generally not

01:05:24.900 | something I would worry about. Just to keep going down this rabbit hole, like is does the smell of

01:05:29.960 | that gas mean anything related to your gut? It can. But that alone is not a problem. And,

01:05:38.760 | you know, I always tell people really look for the change in, for example, the change in your bowel

01:05:44.560 | movement could be that you've been colonized with some bacteria. If you traveled overseas or something,

01:05:49.140 | you may not have a serious infection, but your gut could have been colonized with something or

01:05:53.580 | you've eaten some food that hasn't agreed with you, something like that. In the absence of other

01:05:59.240 | symptoms, blood in your stool, pain, a change in the consistency of the stool or the frequency,

01:06:04.480 | generally not an emergency. But if it persists over time, something to think about getting checked out.

01:06:11.640 | Okay, super helpful. I'm sure that there are some doctors out there or medical professionals that

01:06:18.180 | might kind of have a dissenting opinion on gut health. What kind of evidence would you point to

01:06:24.680 | someone or what would be your reaction if you were in a debate with someone that's like this isn't as

01:06:28.540 | important as you're saying it is? Again, I would have them look down at their belly and say, okay,

01:06:35.780 | look where that is located. That is feeding everything. There is no brain health, no immune

01:06:43.080 | health, no lung health without gut health. Because think about it, Chris, even if you are eating a

01:06:49.100 | fantastic, super nutritious diet, if your gut is not able to digest the food and assimilate the food

01:06:56.500 | through the lining, let's say the enzymatic activity is off or the microbiome is off because the microbes are

01:07:02.360 | involved in breaking down the food also, or the gut lining is compromised, you are not going to be

01:07:07.680 | able to absorb and assimilate those nutrients properly. And we see that all the time. So of

01:07:13.180 | course, the goal is to eat the most nutritious, the healthiest diet you can, but you also have to make

01:07:18.480 | sure that you're also cultivating the healthiest gut you can so that those nutrients can be properly

01:07:24.160 | absorbed and appreciated by your body. It is really the engine for the entire body. It is not just a

01:07:31.320 | digestive organ. It is a defensive organ. It traps toxins in that gut lumen and expels them. It decides

01:07:39.660 | what nutrients get absorbed in through the gut lining to travel through the bloodstream to the other

01:07:44.560 | organs. It unravels viral protein to keep us safe. What about mucus? It produces mucus. Most people think

01:07:51.640 | about the lungs with mucus, but the gut is a main producer of mucus and mucus traps viruses and pathogens

01:07:58.600 | and then expels them either down below or you spit it up. So like now with pollen season in DC, I have

01:08:06.440 | all this mucus and I have to remind myself, don't take an antihistamine or something that's going to

01:08:11.120 | decrease your mucus production because the mucus is being produced to trap the pollen to get it out of

01:08:17.080 | your body. Okay. I feel like we covered so much. What's the one takeaway or next step you want someone who's

01:08:23.920 | thinking about this to do with regard to their own? I want people to look at their GI tract as a sort of

01:08:31.900 | living laboratory in their body and to start figuring it out like, hmm, what would happen if I drank 100

01:08:39.300 | ounces of water a day instead of only the 17 ounces I'm getting? I want to try that for a week. What would

01:08:45.140 | happen if I massively increase my fiber consumption by committing to a huge salad every day or my one,

01:08:53.420 | two, three rule, one veggie at breakfast, two at lunch, three at dinner? What would happen if I had

01:08:58.740 | a big lunch and a light dinner or maybe no dinner? Get playful about it because your gut will give you

01:09:05.200 | that feedback with whether it's taking away something that you're doing that you think, oh, maybe I shouldn't

01:09:11.360 | be doing this or adding in something that you're not doing. Like literally an apple a day, it actually

01:09:16.860 | does make a difference. So I want people to think of their gut as this laboratory, if you will, that is

01:09:23.620 | going to give you this positive and negative feedback. And then I want you to pay attention to it. So when

01:09:27.980 | you do all these things and then you have stool nirvana, then don't stop, right? Don't be like, oh,

01:09:32.340 | okay, that was good. When you see that bowel movement come out, I mean, it's telling you so much.

01:09:36.780 | So I want people to turn around and take a look, as I say, after they have a bowel movement. You know,

01:09:43.000 | you could see something really important. Like you could see blood in the stool that could be a sign

01:09:46.840 | that there's something serious going on. I mean, maybe it's just a hemorrhoid, but maybe it's an

01:09:50.980 | early sign of colon cancer. You could see a very narrow stool coming out that could be a sign that

01:09:56.320 | you're developing something like diverticulosis. So there's so much that your gut can tell you.

01:10:01.440 | Just paying attention to these things and not thinking of this stuff as like, oh, that's gross.

01:10:05.780 | And, you know, we shouldn't talk about that. That's just something you do in private. And then

01:10:09.240 | you never think about again. Absolutely not. This is some of the most important feedback that your

01:10:14.500 | body's giving you. And we need to like really pay attention to it and talk about it and examine it

01:10:19.820 | and follow the crumbs to a healthier gut. Having a really great bowel movement is the ultimate form

01:10:27.020 | of detoxification. And for anyone who wants to go even deeper on this, you've mentioned a few

01:10:31.800 | of your books. We'll link to them in the show notes. You mentioned one episode. We'll put that

01:10:35.260 | there. But where can people just find everything you're working on? Gutbliss.com is a place to find

01:10:40.180 | me. One word, G-U-T-B-L-I-S-S and the Gutbliss podcast. I have a weekly podcast. Episodes are nice

01:10:47.760 | and short and digestible. New episodes drop every Thursday and we get into it. Mama Jama poos,

01:10:54.140 | air swallowing, turn around and take a look. How did I forget? You can join the Gutbliss Gut Club.

01:10:59.800 | So twice a month, you can join me. It's a one hour monthly Q&A. Ask me anything about gut health.

01:11:08.020 | Literally no question is too big or small. And then one hour masterclass every month. I'll often have

01:11:13.160 | guest experts with me, but we'll dive deep into a topic, whether it is side effects of GLP-1 drugs,

01:11:19.300 | the link between brain diseases like Parkinson's and gut health, stool microbiome testing. And the

01:11:26.420 | cool thing with the Gut Club is that people get to vote on the topic. So I love having these

01:11:30.500 | conversations. The podcast is great, but it feels like a conversation with myself because I'm not

01:11:35.860 | getting to talk to people. So join the Gutbliss Gut Club for riveting conversation twice a month.

01:11:42.860 | Awesome. Thank you so much for being here.

01:11:45.100 | Oh, thank you for having me.

Understanding and Improving Your Gut Health with Dr. Robynne Chutkan

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