Master Class on How To Fix Your Digestive Issues & Gut Health (With a Renowned GI Doctor)

Hey, it's your friend Mel and welcome to The Mel Robbins Podcast. The other day I read this crazy piece of research. Did you know that two thirds of people have a gut issue? And you want to know the age group that is the most affected? This one really surprised me. 18 to 44-year-olds. Yep, it's not your grandparents. It's 18 to 44-year-olds. 73% of people in that age range have a gut issue.

So if you're feeling bloated or you're constipated or you have IBS or you're constantly popping the thumbs and you wish that you could do something about it or maybe somebody that you love has one of these issues. Well, I have booked you and me an appointment with the number one gut health medical doctor. I think she's absolutely amazing. I'm talking 30 years of medical experience and she's here to just set the record straight with the medical facts.

She's going to say, throw out your supplements and the probiotics because there are simple things that you can do. In fact, you should do starting today to have a healthier gut to beat the bloat, settle your IBS, and dress constipation once and for all, which you will also learn may be caused by a very surprising issue in your childhood. And you're also going to learn the extraordinary role that your gut health plays in your immunity, energy, mental health, estrogen production, and so much more.

This is a master class on your gut health and absolutely everyone that you know needs to hear it. Hey, it's your buddy Mal. I am so glad you're here with me today. It is such an honor to be able to spend some time with you today. And I want to acknowledge you for choosing to listen to something that can help you create a better life. I think it is so awesome that you're taking time for yourself and I love spending that time with you.

If you are a brand new listener, welcome to the Mel Robbins podcast family. I'm Mel Robbins. I'm on a mission to inspire and empower you with tools and the expert resources that you deserve so that you can create a better life. And I am thrilled to introduce you to a remarkable human being.

Her name is Dr. Robin Chutkin. She is a renowned gastroenterologist who is the founder of the Digestive Center for Wellness, which is an integrative gastroenterology practice where for 20 years, Dr. Robin has been working with patients to help them uncover the root cause of GI disorders. She's been on the faculty of Georgetown Hospital for 27 years.

Dr. Robin received her bachelor degree from Yale, her medical degree and residency at Columbia, where she was the chief resident, which basically means she was the top doc in her residency at medical school. And then she did a GI fellowship at Mount Sinai Hospital. Dr. Robin has also authored dozens of academic journal articles and book chapters.

And she lectures frequently on the microbiome and gut health throughout the United States and Europe. She's also the host of the Gut Blis podcast, the author of four bestselling books, the antiviral gut, Gut Blis, the microbiome solution, and the gut bloat cure. And you're going to love her. And so will everyone in your family.

So please, if you got a friend or a loved one who's been complaining nonstop about their stomach issues, this is a must share. So let's jump in and please help me welcome Dr. Robin. I'm so excited to be here. Thank you so much for having me. We're going to go all things gut, not just the obvious things, but we're going to talk about gut brain, gut immune, how the gut is your engine for your entire body.

It drives all the processes. And I think we're going to really give people a new way of looking at the gut and how powerful it is. Absolutely. And what I also love about your work is you take all this science and distill it down into simple things that I can do you listening or going to be able to walk out of here and know exactly what to do to take care of your health to make your gut better. And you're going to understand why this matter so much.

I'm so glad to be here. So Dr. Robin, it does seem like everybody I know has a gut issue like the bloating and the IBS. Are you finding that in your clinical practice gut issues seem like they're on the rise? They're absolutely on the rise. And as a gastroenterologist, you know, I've always seen a lot of gut issues. But if we look nationally, there was a study done last year by MDV IP.

And they found that two thirds of Americans suffer from gut issues. The highest number is in the 18 to 44 age group. Why 73% I think a lot of it has to do with the food that they're eating. They're eating more ultra processed foods are busy. They're on the go. I think there's a lot of stress. And that has a profound impact on the gut.

And I think they're also more aware, which is good, right? I mean, it's it's good to be aware that this isn't functioning properly. But that's the highest percentage. And what they found the American gastroenterological association did a survey and they found that 40% of Americans, and this is across the board, said that they had GI issues to the point where it was interfering with socializing with running errands, with exercising, with having sex with libido.

Wow. And to me, the really frightening part of all of this is the AGA launched a campaign, a record, trust your gut around this. One in three Americans do not feel comfortable talking to their doctor about gut issues. And we'll only raise it if the doctor asks. It's like, don't ask, don't tell. Because of embarrassment. And honestly, this was a reason when I read this last year, I was like, oh no, I've got to do something about this.

It's like, I want people to be a medical detective. Like you turn around and take a look at that poo. You tell me what it looks like. If you need to poke around in it with a stick. Understand, why do you have gas? Why are you bloated? Why are you backed up? We have to educate people about this, how this works.

And the education that I see out there is mostly the biohacking, take this supplement, do you know this crazy diet. That's not fixing things for people. I mean, the more that we have, I think the sick are people are. So what we really need is we need people to understand.

How they stuff works. Yeah, for the person who's listening, who is in the two thirds, who are experiencing a gut issue, they love somebody who is what is available to them. If they truly take to hurt everything that you are about to share today, Dr. Robin.

Not only is it possible for you to feel better in your gut, because your gut is your engine, it's possible for you to feel better in your whole body for you to have a clear mind and less brain fog, feed a few less fatigued for immune system to work better so that you're not over reacting to things with food allergies or you're not under reacting to things where you can't clear infection.

So the gut is a thing that unites all these different organs and that's the thing that makes me so optimistic because unlike when you think about genetic diseases, you know, you sort of get what you get you don't get upset your delta bad genetic hand. But our gut is changing all the time when we think about our gut microbiome, which I know we're going to talk a lot about.

We know from a study that was published in the journal Nature in 2014, they put people on a sort of heavy high animal protein high fat addkins type diet and then they rested them for a week and they put them on a diet that was more plant focused and they found that within 30 hours of the food hitting the gut, things changed dramatically.

The bacterial composition changed the genetic composition changed in terms of the genes that were turned on and off and the great thing here is you don't have to be a vegan. You don't even have to be a vegetarian. You just have to eat more plants. You have to do some basics. And in fact, the American gut project study from 2019 that asked the question, what do you have to do to have a super healthy microbiome.

They found that the label was completely unimportant carnivore omnivore vegan pescotary and lacto. It was simply the number of different plant foods people ate with 30 or more different plant foods a week being the magic number. So you can have your poor house or whatever it is that you're going to have. I mean all my vegan friends will be very upset. But from a health point of view, the reasons to consider eating less animal protein in terms of the ethics and climate change, etc.

But from a health point of view, you can definitely tolerate a little animal protein on the plate. You can tolerate a lot of things on the plate if you are crowding it out with enough of the healthy stuff with some plants and some water and some movement and some of these basic things.

You just said 30 plants. So are you saying 30 different types of plants or are there 30 like ones that are better than others like as the gut doctor what you're doing different plants per week. And when I say plants, you get credit for fruits, vegetables, nuts, seeds, herbs, spices, beans, whole grains, all of them.

Oh, well, if we include spices and nuts and grains like that, absolutely, you could get 30 different things because I would imagine the variety, what like is the variety also important. The variety is important because they all contain different things when we think of these phytochemicals. So you think eating the rainbow is always a good way to do it. So you get different things from the oranges and you get the like a peen from the reds and you get something else from the green.

And so eating a variety eating seasonally is another great way to do that because you're not in the same sort of peas carrots broccoli heavy rotation. Yep. For, you know, 365 days and it doesn't have to be a lot either. I mean, you're getting enough from, you know, a little handful of berries is plenty. You don't have to eat a whole quart of stuff. So as the gut expert, Dr. Robin, what do you eat in the day? You walk us through like breakfast lunch and dinner.

Absolutely. I like to start off with a green smoothie in the morning, collards, kale, spinach, celery, parsley, mint, a little bit of fruit, usually green apple, lots of lemon. I like to use ensuite and coconut water for the base. So when I drink that, it's like a liquid salad in the morning. I mean, I feel so good when I have that.

So I usually have that in the morning. If I'm still hungry, I'll usually have something high-ish protein, maybe a little bit of smoke salmon, some eggs, or maybe a sweet potato and kale hash. I love that too. And then what are you doing for lunch? Lunch is usually soup. Soup person. Yeah. Okay. And there are a bunch that I make. My husband makes really good soup too. So it's usually split peas or lentils. Sometimes it's just a broth.

I do a really basic soup that leaks onion garlic and scallion sauteed. And then I just blended up with some broth delicious. Sometimes a little curry powder, depending on how I'm feeling. But that's all the good stringy, high inulin fiber. That's really good for your gut microbes. So some kind of soup. Sometimes it's a heartier soup.

And then dinner is usually protein starch veg plus salad. My husband's mostly vegan, not all the time, special occasions. He might eat some meat. So he's usually not doing the animal. He's almost never doing the animal protein. He's usually doing lentils, brown rice, sauteed collards, and salad. And I'll have all of that. But I may have a little piece of fish or some broil shrimp or something.

But it's lots of legumes. It's lots of beans and greens basically. And then some whole grains, love brown rice, eat it probably most days, love squash, sweet potato yams, yucca, all of that stuff. When you're glowing, you're like, this sounds actually amazing. So do you need to take a probiotic? You need to eat an apple overtaking a probiotic. Yeah. This idea. And I will say, I will say for the record, there is a dark chocolate happening every day for me.

Oh, thank God. Tons of fruit and lots of dark chocolate. Okay. And I have been known to eat a bag of Doritos on a road trip. It has happened. Okay. Well, I knew I liked you. But let's talk probiotics because they're everywhere. Everybody seems to be on one. And as the gut doctor, what's your opinion about it? My opinion on probiotics is like multivitamins. Do we have clear and compelling evidence that a multivitamin does anything for the average person? We don't.

What we know from some studies is that people who take vitamins also have healthy habits. So vitamin takers tend to be exercises and clean eaters, it's and meditators, et cetera. But we don't have evidence outside of that that the vitamin itself in a healthy person. So it may help it can't hurt. Even something like a probiotic. If you're taking multiple different species, those bacteria assuming that there are actually live bacteria in the probiotic because there's very little regulation.

A lot of times the bacteria are dead, but let's say there are let's say the product does contain what it says it contains these live bacteria. They're potentially competing for resources with other bacterial species, even the native ones in your gut that are actually working and trying to do their thing. And now they're like, oh, wait, there's not enough of, you know, whatever resources we need to eat. And so you can be altering your microbial composition for the worse by taking a probiotic.

Oh, God. Now, well, I feel like I'm in the camp of everything you just said, it can't hurt. And so I'll just keep like taking all these things and my body will just pee out whatever I don't need. So that's one mistake I'm clearly making. Second mistake that I'm making is I'm taking the probiotic. And then I'm taking a different probiotic. And then I'm also eating the yogurt and the kimchi.

And I'm just making this gigantic sort of bacteria. But eat the kimchi for sure. I mean, we have great data on fermented foods. And a lot of this is from the son of burn lab in Stanford. So kimchi and South Crout are this powerhouse combination of pre pro and postbiotics. And there's really compelling data that eating even a tablespoon of South Crout a day can provide multiple different species important metabolites.

And this ultimately sort of medicinal food, wow, things like the South Crout and kimchi. So by all means keep doing that. Dr. Robin, what's the difference between a prebiotic and a probiotic? A prebiotic is food for the bacteria. So that's typically healthy, fibrous foods, probiotics refer to the actual bacteria themselves. Not just the one you're taking as a supplement, but the ones in your gut. So probiotics are bacteria and prebiotics are the food that bacteria eat.

Got it. And I want to try to bring in a visual. So if you've ever made bread and you have that sort of you're starting it and you've got the yeast and the and you then feed the yeast with the flour and it starts to bubble. The prebiotic thing is sort of like feeding the yeast and I was like, oh, yeah, I'm really hungry. And I'm getting going. Okay, got it. The probiotics, the actual other forms of the bacteria that you got it.

So what are the foods that you need to eat to like have both the prebiotic piece and the probiotic piece for prebiotic, which are the foods to feed the bacteria. Think high fiber and think stringy fiber like asparagus and celery and also things like oats, dandelion greens. These are all great foods, fibrous foods to feed your bacteria for probiotic foods. Think about fermented.

They also contain prebiotic with the fiber, but think about fermented foods because those are producing bacteria during the fermentation process. And I do want to say it's not that a probiotic is a total waste of time in my practice where I treat really sick patients with Crohn's and Ulst of Colitis.

There are probiotics on the market that have the FDA label as a medicinal food. This is a medical food for the treatment of inflammatory bowel disease, etc. Their products that have over a hundred different scientific studies behind them showing that they work for these particular conditions.

But that's different right that's like the B12 for the Crohn's patient that's not the average person the data that the average person gets a lot of health benefit or really any health benefit from taking a probiotic is a little murky or and my concern is always that people are going to say,

oh, I don't need to change my diet or really pay attention to that because I'm taking the probiotic. I mean, you're actually eating the kimchi and doing all the other stuff which is fantastic and I'm popping the probiotic and you're probably okay, but you don't need it.

But I do I do want to caution people if you're taking these high dose probiotics, are you potentially using up resources that your native bacteria that need these resources and how would you know like would you be bloated even though you're taking a probiotic like how would you know that it's backfire.

You really don't you really don't there's not a test we can do for that, but what I want people to remember is that when you take a probiotic product those bacteria maybe living half an hour, I mean typically under an hour in order to get meaningful colonization and repopulation of the gut.

You have to feed them and so the food is ultimately more important because the truth is it's not that you don't have any healthy bacteria in your gut the population is low. How do you get well population may be low say you've taken a lot of antibiotics or you've had a crummy diet. How do you manipulate the microbiome and get those healthy species to grow by feeding them not by bringing in more species that are basically going to like hang around 20 minutes and then you're going to poop them out.

So it's really this whole idea of repopulation and recolonization and we do that by feeding what's already there and that has been shown and that's the American gut projects study with the 30 different plants when they asked the question. What is the most effective way what is the most important thing to do to have a healthy microbiome and this is a study done in over 10,000 people 40 different countries, so really meaningful data.

And the most effective thing was to get 30 different sources of plant based foods in your diet once a week. Yes, throughout the week. Wow. So it's still really diet. I mean if you look at an apple that's grown organically and even better biodynamically. Biodynamically when you have the animals fertilizing the soil. So you have from a local farm.

Exactly. Local farm. I love it. Yes, that is exactly local because it's going to be more nutrient and micro bridge because it's not travel 3000 miles on a plane and barely. And I guess you in order to keep the thing. So an apple and apple you can get millions of microbes from eating an apple grown locally. So Dr Robin, I'm just imagining that the person listening is sitting here next to me and we have come to you because we feel bloated or we're struggling with IBS or constipation or whatever.

And so it is just kind of a classic gut issue. What are the three small habits that you would like us to start implementing into our day to day life that are the best things that we could do that will build a healthy, beautiful kind of gut microbiome and get our gut system working correctly.

There are tons of things to do, but if I had to distill it down to three, I would say it's hydration, it's movement and it's fiber and the movement that's smooth muscle, it's not skeletal muscle, so it's not on the voluntary control, but we know that movement creates nitric oxide and nitric oxide is part of what keeps the heart healthy and keeps the gut healthy.

And so the movement stimulates parasitosis. If you don't have things moving through in a timely fashion, not only do you have symptoms like bloating and constipation, but you also have stasis of those intestinal contents and you have bacterial overgrowth because things aren't moving through.

So the movement is really important and I found that since pandemic so much so many of us are so sedentary. I know that I'm not at the hospital a few days a week anymore back and forth where I'm probably walking four or five miles every day.

I'm sitting a lot more and I think we've seen a huge effect of that of the effect of being sedentary on the gut. So we need to stimulate gut parasitosis. The people we see with the worst GI problems are people in nursing homes and it's not because they're elderly, it's because they're not moving.

So movement is really key. Hydration, I can't say it enough times plumbing. We've got to on-clock those pipes and then the fiber because the fiber feeds are got microbes so they can ferment that fiber, create all the healthy metabolites. And it doesn't have to be like some enormous kale salad. It can literally be grab a carrot as you're walking out the door and chomp on it.

Throw an apple in your car, eat some nuts, something basic, ideally something on process, right? I love how accessible this is because based on everything that you are teaching us your body is naturally designed to work in the correct way.

It is plumbing, it's trying its best. And so if you get all different kinds of plant-based, fiber-ist foods in, the research says try 30 different types of spices and foods in it. And if you simply walk more, you're saying that that's three things that we can do that will help over time, create a healthy gut. And so the tremendous benefits, tremendous, you know, the water thing is like a drug when you really start to, and I was one of those people who for years walked around sort of dehydrated.

I mean, I drink a lot if I was at heated vignasse flow, yoga or running, but other than that, I was like, I can't be getting up, seeing patients, I don't want to get up every five minutes and have to pee. And then I started measuring and drinking a hundred ounces of water. I noticed a tremendous difference. I mean, I already have pretty good poos, I have to say. I'll show you some pictures later, Mal.

These, I mean, just dramatic improvement, and they perk up like how briskly they come out because things are lubricated. You know, I never thought I would say to a GI doc, I could listen to you all day, but I could. And there are so many people in my life, Dr. Robin, that need this information. And so I want to take a quick pause so we can hear a word from our sponsors. They bring you, Dr. Robin at zero costs. Let's give him a little love.

But you know, who also I want you to give a little love to the people in your life that need this life changing information, those friends that are complaining about their stomach, the people that have all kinds of issues, send them this episode, it could really change their health and change your life. Alrighty, don't go anywhere. We will be waiting for you after a short break with more from Dr. Robin.

Welcome back. It's your friend Mal and you and I are here with the incredible Dr. Robin Chutkin. And we're learning all about gut health. I really do want to dig into having you help us understand specific gut issues, like bloating and IBS and some of the things that people really struggle with. But before we go there, I would love for you to explain to us why should we care about a healthy gut? And what I'm trying to ask is, what is it impacting when your gut is healthy and when it's not.

I said earlier that there is a big connection between your immune system and your gut health, which I didn't know. And so if you could just elevate this issue for us at the highest level, like why beyond our plumbing working, does your gut health mean total health?

The gut immune connection is probably the most important connection for the gut and other organs. You have the gut lining and on one side you have the trillions of microbes in your gut, your microbiome. And on the other side, you have the immune cells. And that gut lining is only one cell thick. It's a razor blade separating your gut microbiome from the immune processes. And it's a hand and glove relationship. They're working together.

Literally the microbes are like the lookouts and they're like, oh, something problematic coming along. They trigger the immune system. In some cases, they actually kick on the lining of the gut. They push on it to trigger the immune processes. It's a physical interaction sometimes. But they signal the immune cells on the other side to say, oh, whoa, something big. Here comes Ebola or SARS-CoV-2. You guys need to get ready. Mountain immune response. Start making antibodies. T cells mobilize.

Let me just make sure I'm understanding why this matters because based on what you're consuming through your mouth that gets processed through this 30 foot tube. Your gut is extracting intelligence that mobilizes other parts of your body to help you outside of this tube. Absolutely. Your gut microbiome directs your immune system. It literally trains it. And this is why we see there's a fascinating theory called the hygiene hypothesis.

And it was developed by David Straun. He was an epidemiologist in Britain in the 1950s. He did a study of over 17,000 children from birth to adulthood. So long period of time to figure out why they were seeing these high rates of autoimmune diseases in England and sort of post industrial London.

And he found that kids who were exposed to more germs who were living in large households, where cousins and siblings were always sneezing and coughing on them. They were immunized because their immune system had been trained at an early age. How to differentiate between friend and foe and whether to mount an immune response or not.

How high an immune response. Kids who are super clean, who were never sick, they had higher rates of autoimmune disease later on. And Mel, if we look at a map of the world today, we still see the effects of the hygiene hypothesis.

We still see high rates of autoimmune disease in countries where they're higher levels of sanitation. There's more washing. There's more chlorination. There are more chemicals. There are fewer microbes compared to less developed countries where people have close contact with animals. They have close contact to the soil. They're growing their own food. So the immune system needs exposure to microbes early on in order to train it.

So it can set it at just the right level. What we're seeing now in more developed countries like the United States is we're seeing an overactive immune system, which is manifest as autoimmune disease, one in four Americans. Many people have multiple or allergies, food allergies, everybody's got an allergy. Why? Why do we have a food cause of an over reactive immune system? And why do we have an overactive immune system because of what's going on in our gut? There is a very direct correlation.

Let me see if I can explain this to myself. So you're basically saying that when your gut is out of whack and it's getting all kinds of mixed signals because if your microbiomes and the gut health isn't intact, it's actually not able to either break things down or read what's coming in correctly. And then that means it is not able to signal an efficient and effective way to your immune system that either we got to go into battle or everything is OK. And so because our guts are out of whack.

We're not getting the hydration. We're not moving. We're not taking care of ourselves and eating the virus foods. This is causing our immune systems to go haywire. And this is so fascinating. And I actually I actually read somewhere. I don't know if this is true that 80% of people that at least in the United States that have an autoimmune disorder or women. Yes. Why does this happen? Very high range. And Gabo Mati talks about this and other folks.

We think it may have something to do with the effect of the female hormones estrogen, progesterone, et cetera, and the interaction with the gut. And also because some of these genetic predisposers for autoimmune disease are sex linked to their tide to the X chromosome. So a couple of different reasons.

I also worry about the personal care products, the cosmetics, other things that women tend to use more of that are getting absorbed into the body and how those might be affecting woman because you know you think about it. You put makeup on at 10 o'clock in the morning at 10 o'clock at night. It's like, where's the makeup? It's all gone. Where's it gone? It's got absorbed into our body. And again, I'm not saying that makeup causes autoimmune disease. Let's be clear.

But we put a lot of things on our skin and after our GI tract, our skin is our next biggest digestive organ. Our skin literally digests the things we're putting on it. And so we have to also think, you know, what are we putting on our hair or skin, et cetera, that could be getting absorbed into our body that could potentially be triggering an immune response. So that's just one of several theories. And like most diseases, like cancer, like dementia, it's not one cause.

Right. It's multiple different factors. But is there researcher, do you see in your clinical practice? If you are doing these interventions that anybody can do, drink more water, move your body, eat more like fiberless foods in your diet, when you can start to get your microbiome and your gut health and your plumbing, working as it should. Do you see an impact on an autoimmune disorder?

Most of what I do in my practice now is helping people with complex autoimmune disorders, like Crohn's and ulcerative colitis, get off immune suppressing drugs. And do you know how we do it, Mel? No, we do it with diet and lifestyle. And if you had told me 27 years ago, when I finished my GI fellowship, that I would be treating complex autoimmune diseases with food, I would have laughed at you. And I would have said,

that's focus, focus, craziness. But now when I think about it, I think about my colleagues saying to me, does that stuff really work? And I'm like, are you asking me? As a fellow gastroenterologist, if what you put into your gut affects what's going on in your gut and you're asking me, is that how it, I mean, of course that's how it works.

What we put into our gut profoundly impacts what's going on in our gut and what's going on in our gut profoundly impacts what's going on in the rest of the body. So I mean, it's, it is very contrary to the prevailing wisdom of all the biologics and the immunosuppressants you see advertised on television and that's a gazillion dollar industry. But I will tell you, Mel, we have published data on this and we have a success rate of about 79% getting patients off of these biologic treatments.

Now, I will tell you it doesn't work in everyone and it's a cherry pick population because people are coming to see me, fancy GI doc who, you know, they've got to travel out whatever come and see and they're motivated. But the, but the intervention is what anybody could do. The intervention is what anybody, the intervention is not any special diet, you have to go and buy or products.

It is, I mean, we sometimes do use this very high potency probiotic, the one I mentioned that has the indication as a medical food for IBD will often use that in conjunction, but it's always a dietary change and I'll tell you the diet that I put. What is that it's similar to what I eat it's a green smoothie in the morning and I tell them if you do nothing else.

Do this green smoothie get in your three leafy greens a little salary the parsley and mentor for me just for flavor fruit ice little lemon for taste get that in the morning and I usually start people on about 12 ounces and then I work them up to 40 ounces of this green smoothie.

Okay, and it's all just stuff you buy at the supermarket and I always felt like I was sort of alone out there in the wilderness saying you know eat food real food it will make a difference so green smoothie in the morning and I tell people look if you're still hungry, have some eggs, make an omelet definitely have something else for sure.

And then for lunch it's usually something based around plants so I'll encourage my patients I'll say get a salad that's usually easy for people to get and if you want some animal protein go for it but make sure it's a big salad and ideally put some chickpeas in there some hummus on the sides of lots of plants okay and then for dinner if you are an animal protein eater your protein your start your two veg plus salad and that's it there's a

sensible eating and it's also getting people to cut down or ideally eliminate the ultra processed foods the package foods with all the emulsifiers in my neck of the woods for autoimmune diseases in the GI tract we see that the emulsifiers is so less of

that it's not so much of a lot of the other things that are more important than carodine and those things are particularly bad for the gut and we think it's not so much of microbiome but it's a gut lining that they compromise a gut lining in some way what are some other parts of your overall health that are driven by gut health that might surprise

your estrogen levels I did not learn this in medical school when I found this out a decade or so ago I was mesmerized by something called a strawberry and the strawberry refers to a collection of bacteria in your gut that metabolize estrogen

so the estrogen is made primarily in the ovaries and a little bit in the adrenal glands and it travels through the bloodstream to all the different parts of the body that have estrogen receptors and that's not just the uterus that's also heart tissue different parts of our brain etc that have estrogen receptors

and then the estrogen that's not used gets transported it gets into the bile and it gets excreted into the gut and it gets recycled through the gut so there's certain bacteria in the gut that help to recycle that some of it gets excreted out and some of it gets reabsorbed back through the lining into the bloodstream

if the estrabalom is disrupted you get higher levels of reabsorption than you should and you end up with a situation called estrogen dominance where you have too much estrogen on board and that is associated with a lot of conditions with fibroids, with endometriosis, with a lot of the menopausal symptoms we think of and again this isn't the only reason for sure

but this is most people don't realize that the gut plays a huge role in estrogen metabolism so if you've been taking antibiotics non-stop for whatever they may have been prescribed from decades exactly not you know I had a strep throat I took antibiotics but somebody put you on antibiotics for your skin told you have a chronic inflammatory condition maybe Rizesia take these antibiotics or because you're getting frequent urinary tract infections

take the antibiotics every time you have sex and you know that could add up depending on who you are so so many of the patients I see and so many women in particular are put on these suppressive antibiotics not to treat an actual infection but to treat inflammation or to prevent an infection and that ends up being ruinous to your gut bacteria and that ends up affecting your estrogen metabolism

and throwing your estrogen levels off balance so I really particularly for my menopausal woman and particularly because I'm a menopausal myself really focus really take a gut centric approach to that to really look at you've got to have a healthy gut if you want to go through menopause successfully and there've been some really interesting articles Dr. Neil Bernard at the Physicians Committee for Responsible Medicine

and they're very much a plant based organization they published a study that looked at a plant based diet for visa motor symptoms and menopause for hot flashes way more effective than hormone replacement Wow and and the thing that I find in my patient population is it doesn't have to be a completely plant based diet now Neil and his colleagues were wonderful people would tell you that it should be

but you know we live in the real world and not everybody's going to become a vegan to control their hot flashes but just eating more plants and eating a plant based dinner having your last meal before you go to bed be primarily plants can help dramatically if I want to induce a hot flash I don't have many more

but if I want to induce one I have a poor house state and some red wine at night and I just gonna say the same thing up all night just gonna say the same thing because digestion is such an active process and particularly digesting animal protein that's high in fat high in protein requires a lot of blood flow a lot of enzymatic activity that leads to a lot of dilation and flushing and of course the alcohol is gonna

be a dilate you too I think you just inspired me to make a major change especially during the weeks that I have like a really big workload or I'm traveling for works I got to get up in the morning give a big keynote in front of thousands of people I always think oh I should have a steak tonight I should have a piece of fish tonight I should have a big protein thing to carry me through and what I'm gathering from you is I would be way better off if I heavy loaded on the leafy greens and the best

vegetables and a lot of water at night because it would allow my gut to just flush itself and I guess yeah and think about I mean the protein can be satin and it can carry you through but think about having a high protein breakfast the day before like have an omelet the day before or have more protein at lunch but then for dinner really lighten it up early and light

super solid perfect you know I love this because so many of the experts that have come on because you've been talking to a lot of people about hormones and menopause and for women in particular how you age well so that you have energy and you're strong and you're able to be like vibrant and as you age and so much of the message is about resistance training and just lots and lots and lots of protein right and so I think really trying to get the big protein

in the morning and at lunch is the way to go but I like so I'm learning so much can you explain the connection between the gut and the brain to the person listening the gut brain connection is another fascinating one I think got immune and got brain right now we have a whole separate nervous system in our got called an

outbreak nervous system and it's many many millions of nerve cells in fact we have about seven times the number of nerve cells in our got that we have a spinal cord not as much as we have in our central nervous system clearly but the gut is a very innovative organ

lot of a lot of nerve cells okay gotcha it also communicates directly with the brain via the Vegas nerve the 10th cranial nerve messages going back and forth the gut also is where most of the neurotransmitters are produced serotonin the feel good hormone dopamine several others most of them are produced in the gut they're co-manufactured by bacteria I think that is a surprise to most people because you hear the word serotonin and you think brain yeah but you're

going to tell us doctor Robin no no no you're got health is critical because the serotonin that you need most of it is manufactured in a healthy in a healthy gut so what we see is that with a disrupted gut we see abnormalities in mood in cognition in memory and conversely because it's

high directional it's got affecting brain and brain affecting gut we see the brain influence on got motility enzyme secretion an absorption of nutrients so you've got to have it in balance and it's it's not either or it's not either you take an SSRI or you eat healthily it's both and particularly for young people the idea that you can take a young person who's having with mental health issues and they can be you know eating cheetos and cheeseburgers while you're

meditating them and you're not paying attention to what they're eating is magical thinking we have to pay attention to that for brain health also is there a scientific link between like depression and anxiety and gut health there are and like a lot of these conditions it's multifactorial but I'll give you just a basic example there's a bacteria called Campola Bacter Jijunai which is a common cause of foodborne illnesses and sometimes people will get it with a

travels diarrhea when they're out of town or something in mice if you inject a large inoculum of Campola Bacter Jijunai you induce anxiety in mice what's a human carlet for that post infectious irritable bowel syndrome which is what we refer to when somebody has a change in bowel habits that's happening after an infection like Campola Bacter Jijunai post infectious irritable bowel syndrome doesn't just affect your bowel habits where

now the bowel habits are irregular maybe they're loose or they're more frequent it also frequently involves changes in mood people say they're more anxious you know I went to the Caribbean I got travels diarrhea I was in Mexico I got Montezuma's revenge and I came back and my bowel habits haven't been the same but I also find I'm more anxious my mood seems to have changed and we think a lot of that is mediated through the change in the microbiome

Wow let's talk about IBS because I have a number of friends and family members that are struggling with it so what should somebody do if they think they have IBS what would you say these are the steps I would

take before you go running for some sort of drug number one is you have to figure out what is causing it and I'd like to think in terms of general category so is it something mechanical if you're a woman when was your last ultrasound you have a big fibroid could there be an ametriosis do you have an

antiverted uterus or a prolapse bladder or something that's pressing on it so what is the anatomical mechanical thing going on that could be causing symptoms okay medicine cabinet is a big one and it's not just prescription drugs but it's also over the counter and supplements so you need to look at the side effects and what am I looking for all of them you're looking for things that have GI side effects nausea vomiting diarrhea constipation and when that every medication it's a lot but I'll

tell you when they list side effects they list the most common ones first it's like ingredients at a food label right so the most common ingredient is listed at the top and by common you mean this is the

side effect we see the most exactly okay yes so if you see nausea vomiting abdominal pain constipation diarrhea in the top five and and you are having some of those symptoms that's something that's worth checking out and again not advocating that you take a drug holiday on your own but talk to the

prescriber and and here's the thing your psychiatrist might be prescribing a drug for you for anxiety and the drug may be helping your anxiety but it may be causing a whole different problem in the GI tract I have to remind people that just because something is helpful doesn't mean it's a good idea

and I tell people all the time if you're tired and I gave you some cocaine it would pep you right up but does that mean cocaine is a good idea for treating fatigue so in my practice I spend so much time trying to undo sort of medical misadventure I like to call it where a very well-meaning physician

prescribes something for his or her neck of the woods a kidney problem a psychiatric problem a lung problem and it's going great for that problem but it's messing up my organ now so we're very siloed in medicine you know the nephrologist is the kidneys and the pulmonologist is a lungs and

and everybody's just sort of focused on their thing and because the medicine cabinet is such a problem the GI tract and and as you said Mel but you know don't all these drugs have GI side effects many of them do because you know you ingest them so they potentially affect the pH of the gut

they potentially affect the gut lining and they potentially affect the gut microbiome and then those things affect the immune system etc so it becomes a sort of whack-a-mo like you whack one problem hair your high blood pressure fantastic blood pressure is controlled now we have a problem over hair

so we whack that with another medicine and so it's poly pharmacy and when I see people the first thing I want to figure out is is this a side effect I'm treating because it often is right so is there constipation or they're bloating a side effect of a medication they're taking

and the the sometimes challenging thing is people don't want to hear that they want like the magic potion like give me the magic supplement probiotic that's going to make the cell go away so I have people bring their medications they're over the counter the supplements everything and I

lay them all out on the table and the people in my office always laugh because I always have my rubbish bin right next door because they're like oh this is going to fill up and I'm like okay this one what's this one for and to be clear I would never tell somebody to stop a prescription

medication that I didn't prescribe I tell them this one you got to talk to your prescriber about but I divide it up and usually by the time I'm done it's a pretty small group that's what is kind of the first thing that you're like no no advill no ask for no this like the thing that you

can take all the time you got it the non-striple anti-inflammatory drugs what is it advill anison aloeve ibuprofen so when we look at the emergency visits for gastrointestinal bleeding number one cause too much too much ibuprofen wow people don't realize that over indexing on this

stuff can cause fatal gastrointestinal bleeding there was not a weekend on call when we were not in the intensive care unit with our scopes trying to stop dramatic you know near fatal gastrointestinal bleeding so these drugs can be potentially really dangerous you have to be careful with them

and I'm assuming that if this is kind of the detective work you're doing that it's still the same three things that you would recommend in terms of movement and water and diet over compensate but you got to you can't fill a bathtub with the stopper out right so if you're trying to

improve gut health fill the bathtub you have to make sure that it's stopped up that you're not draining all the good stuff you're doing out I like this concept of personalized medicine but personalized medicine not in the sense of like you know all these wonky tests and supplements

but personalized medicine in terms of sitting down and really figuring out water the things that you're dealing with and what is a background noise what is a platform on which your symptoms or illness live is that platform uh standard american diet you know

only eat a broccoli a broccoli florett once a week as you're only vegetable is it massive amounts of antibiotics in childhood as was a case with my daughter is it really sedentary and no time outside so you've got to look at that platform see what you can change and then start to add on

right you don't just start adding on all the medication without really and even thinking about the other medication how are these four other medications you may be taking for high blood pressure or something else how are they affecting the liver as i'm listening to you i'm not only thinking

about myself and the personal listening but i've got at least five people that i have to send this episode to like right now and so let's take a quick break so we can hear a word from our sponsors and while you're listening to the sponsors share this episode with your friends and with

your family anybody that's been complaining about stomach or gut issues they need doctor Robin in their life so send them this episode and don't go anywhere because we'll be waiting for you after a short break stay with us welcome back at your friend male robins and you and i are here with the incredible doctor Robin Chutkin and you and i are learning absolutely everything related to gut health and more importantly i want to make it better so doctor Robin here's where i want to go next one thing

that i want to talk about with you today is poop like what should we be looking for what's healthy what's not my favorite thing to talk about and now i am so curious about your poop if you are willing to share i know i'm not the only one who wants to know like what are male robins bowel habits

like well i you know i'm the kind of person you ask the question i'm going to tell you so i'm happy to talk about my poop i have a feeling that you have wonderful poos because you just you have this glow you seem really healthy okay do you really want to know yes i want to know so i am a

once a day person excellent i typically go in the morning and i have one of those little stools that squatty potty yeah that you that you put up and if i can't find a stool like if metal hotel i pulled a little garbage can over and stick my feet up i have like a very i think it's healthy

i mean i don't even know what healthy poop is i just know that when it comes out kind of in one shape perfect it's somewhat soft and held together and there's not a lot of strange objects in it that that's probably healthy i don't like it like i like if i have a situation where i'm not

doing well and i'm super stressed i might go a day without pooping but typically never more than a day or two and then when that happens it looks like milk duds and i know i'm in trouble and i'm not healthy how am i doing doc stool nirvana baby is that what you got

it stool nirvana you hit all the so daily good color formed and it also sounds like you feel good when it comes out right there's that feeling of like yeah i am tade i detoxed all good to go they're man i'm pretty efficient like i don't spend a lot of time in there i can get in i can get

out but that does beg the question how often should you be going how often do you eat do you eat every day of course at least once a day yes you should be eliminating once a day so this idea we have this textbook definition that it's you know three or more bowel movements a week is normal

but if you're going under three you're constipated it's a very arbitrary number and when we think about constipation we're usually thinking about things like consistency you know is it stool hard or is it soft how much is coming out but it should absolutely be a daily thing because that's what it

is it's elimination it's eliminating dead blood cells it's eliminating bacteria toxins etc undigested food particles that stuff is not supposed to be gumming up your cola and just sitting there right everybody that does not go number two once a day just lean in and thought oh gosh

well what do i do so if if you're somebody that is not going once a day that doesn't have kind of a satisfying experience with this are kind of reliable what are the first couple steps that you want somebody to do i think the first thing again is recognizing that this should be daily now that

being said if you skip a day here and there you're traveling schedules a little bit different that's nothing to worry about but how can we help people go every day so i want people to consider a couple things what they're putting in how they're stimulating the gut and that's primarily

with movement and what they might be doing that's slowing things down the gut motility so what you're putting in you want to make sure you're putting in a fiber you want to make sure you're putting enough water liquid it's plumbing the GI tract is pipes in fact a plumber was at my

house one day fixing something and i was standing over him and he kept looking at me and he was like are you know are you checking what i'm doing i'm like no no no we're just in the same business you just make a lot more money than i do so i'm just looking at what you're doing here but it's plumbing

it's one long pipe from north to south about 30 feet long and things get clogged along the way and what do you do when your pipe is clogged thin liquids lots of water so i tell people my rule of thumb half your body weight in ounces of water as a minimal and that's just plain water we don't need

electrolytes in it we don't need flavoring those things often are irritating to the gut so just plain water half your body weight in ounces of water as a minimum and that makes a tremendous difference i can probably solve 50% of the constipation i've seen my office just by getting people

to hydrate wow and by the way as you know great for your skin and everything else right so so many of us are walking around dehydrated so takeaway number one is thinking about your gut system as a 30 foot long plumbing system it starts with your throat moves all through your body and write out the

shoot at the you know absolutely and that half of your body weight is what you should be hydrating with just plain water every day and as a medical doctor specializing in this 50% of constipation issues can be solved by simply hydrating correctly i mean it's a generalization but 50% of the people

i see in my office who are bloated and constipated and you know things are sluggish when i get them to really start hydrating things perk right up i also want to point out that the female plumbing system is very different from the male plumbing system oh how and that's because of three main

reasons so if you have had a colonoscopy if you're 45 or over you should have had a colonoscopy and you may have been told particularly if you're a woman that you have either a redundant colon or a torturous colon or a twisted colon and the reason that's more common in women is because of

anatomical differences so number one we have a longer digestive tract our colons on average are about three to five inches longer why well that first of all it may not seem like a lot it seems like three to five inches three to five inches like if you think five inches that's like from your

rear end of your belly button exactly it is a lot and that extra length creates more looping and twisting and so things are more likely to get stuck and that's one of the main reasons women tend to be so much more bloated and constipated the reason why is to allow for more fluid absorption

during pregnancy so fluid the colon does two things it gets a product of digestion from north to south what does more than two things but two big things and then it also reabsorbs water from the inside from the stool through the lining of the colon into the bloodstream so the reason that woman

have a slightly longer colon is so that when we are pregnant we can reabsorb more water through the colon to maintain the amniotic fluid let me just see if I can extract that so that those of us without your amazing medical knowledge and degrees understand this because I think that's fascinating

see did you just say that one of the things that your colon is doing is when the waste is moving through your colon the colon is actually removing water yes and moisture from the waste matter and recycling that water through your body so that as a woman you can make the amniotic fluid you can

do other things that are part of the reproductive cycle 100% and so when if you were to go up into a colonoscopy as somebody is having a bowel movement which I don't recommend we'd like to have the colon cleaned out when we're doing that what you would see is that when the stool hits the top

of the colon yeah it's liquid what it's liquid and it's green it's billiast fluid and as it moves through the five to seven feet of colon at the end the fluid gets reabsorbed so that what comes out at the end is a beautiful melrabin stool nirvana chocolate brown gorgeous we need to make

some t-shirts for you that say I have great poops oh my god I don't want people looking in the toilet and going that looks like melrabins right there smiling right back at you yes so I so at the end you get this chocolatey brown thing so what how do you turn liquid green at the top of the colon

to solid brown at the bottom the colon reabsorbs the fluid and all the bacteria that are primarily in the colon your bacteria throughout your whole GI tract but they're concentrated at the bottom the bacteria get dumped in the dead bacteria and the dead red blood cells and that turns it brown

and so that process happens in the colon the absorption of nutrients the vitamin A D E N K the iron all that stuff gets absorbed upstream in your small intestine so the function of the colon transport the products reabsorbed water ferment the products of digestion with all the gut bacteria

so that you end up with a chocolatey brown stool this is fascinating isn't it I mean it is so fascinating who is so fascinating so the longer colon is just reason number one reason number two why we're more bloated and constipated is that we have a deeper wider pelvis the female pelvis

is called a gynecoid pelvis and the male pelvis is an android pelvis what that means is that our colon falls deeper down into the pelvis where it has to compete for space what else is in the pelvis your uterus your fallopian tubes your ovaries your bladder that's a lot of hardware

in men they just have a prostate gland that's about the size of a walnut so there's much more room if you look at two skeletons side by side male and female you can tell the female the pelvis is like wings and the male is straight and again what's the reason child bearing so that we can

accommodate a whole human being down there so that's reason number two so these are both sort of anatomical reasons right longer colon deeper wider pelvis reason number three we have lower testosterone levels okay well what does that mean testosterone does a lot of things and again you know it's not

that we don't have any but we have less and one of the things testosterone does is it makes the muscles in the body kind of stronger more rigid so men have a tighter abdominal wall because they have more testosterone so even a man with a big bear belly he'll complain about having a bear belly

but he won't complain about being bloated because underneath his bear belly is a nice tight spanks and we've got a stretched out spanks because of the lower testosterone levels so these three things really conspire to blow down constipate us and if you look at the medical literature you'll

see all these articles about why colonoscopy is harder in women it takes longer we require more sedation and that's true but it's not because we have a lower pain threshold it's because we have all these anatomical things that you know are there for reason they're not a design flaw but they

also conspire to make us more backed up can we talk a little bit about constipation love talking about constipation why you love talking about constipation constipation is so satisfying because there's so many different things that cause it and often people are dealing with

two or three things and when people feel better it's like you know they're so happy and the other reason I love treating constipation sorry to interrupt is because bloating is constipation's fellow traveler and so when people are constipated they're almost always bloated because they're

just plugged and so when you relieve the constipation you de bloat them and they're thrilled and the other thing is a lot of people who are bloated don't even realize they're constipated you can have a bowel movement every single day and still be constipated you can have two bowel movements a day

and be constipated if you are having something called incomplete evacuation tinesmas and tinesmas is like the new insomnia so think about it when we think about insomnia we think okay I've trouble falling asleep but most people have insomnia don't have trouble falling asleep they go to sleep fine

but they wake up and they can't go back to sleep I mean I know that's my issue I go right to sleep and I pop away can I start ruminating and I can't go back to sleep well constipation tinesmas is kind of like that it's not that you're not going you're having a bowel movement but it's incomplete

and you can tell that your colon is an empty you know you've got that like feeling like I still got something on the launch pad yeah and often it's a schmary wipe because when you wipe and there's still a lot of stool on it that's because there's stool still in the rectum that hasn't come out

so you don't have that good clean wipe where it's like ah look nothing on the toilet paper that's that's part of stool nirvana is a clean wipe so what so you said that there were lots of different causes and lots of different things you can do so can you walk us through the things that cause

constipation that might surprise people it's very similar to the irritable bowel syndrome to the ibs classification so mechanical do you have a voluptuous venous colon do you have fibroids have you had surgery and you have scar tissue do you have a prolapsed bladder or rectum so what's going

on mechanically medicine cabinet I think I beat that horse to death and then hormones do you have potentially undiagnosed hypothyroidism do you have are you early menopause and now you're more constipated because of that and remember perimenopause starts like 10 years before you stop

having your period so could it be a hormonal problem could it be a physiological motility problem and the motility is very tied to the composition of the gut bacteria so believe it or not antibiotics that you took 10 years ago and affected your microbiome can now be causing your gut to slow down or

go too fast and not function properly I have somebody that I love that is chronically constipated and like we'll go four or five days and that is consistently what their experiences and what do you think the reasons are have you idea have you done any slew thing I have and it's a very healthy

person exercises all the time has a very clean diet does not take any like not a lot of medication young and I personally think it is an issue with the muscles and not like somehow training yourself to clench when you should be releasing it's a huge category and I'm so glad you brought it up

because I had overlooked that when we were talking about it so that you just grab with this means because I think for people that also have a shot they're your shy about pooping it's around people there the medical terms are things like enismus and some of these are pelvic floor

issues and I know you've had pelvic floor people on but it is tightening when you should be releasing and what we're talking about here now isn't really a pelvic floor issue it is a muscular issue and it's exactly what you said shy bowel the technical term is parcoprisis it's also called

psychogenic fecal retention and it's classified as a psychiatric problem but there's some really important physiological things that make me think it's misclassified as a psychiatric problem so could somebody have constipation and you actually have shy bowel like you get in there and you're

so contemplating you're like I got I got why can't I get like a comment as you're like stressing and tensing you're actually in this almost like traumatic response to pooping because you're so stressed about being constipated is this like a thing it's the immediate stress but more more so

it is what happened before so people who tend to hold their poo in yeah so you have to have a bowel movement but there's not a good bathroom or you don't have time you're at the airport and you worried that your flight's gonna board without you or you're at school and the bathroom's

gross and there's space between the door and people can see and hear and smell and you know there's noise associated with it it's one of the most important things for bowel hygiene is to not have stalls because even people like I am the least shy about bowel movements but I mean I don't

want to have a bowel movement in public but I don't care I'll be in the stall talking to you that's not really normal most people do not want to be in a bathroom with four stalls having a bowel movement talking to somebody on the other side of the door they're like no they want privacy

having a bathroom where you have a toilet and a door that closes a not stalls hugely helpful for good bowel habits because a lot of people will be comfortable going to the bathroom in that setting so you have these two muscles you have the internal sphincter which is under in voluntary

control meaning it's going all the time it's tight it's tight it's tight to prevent leakage yeah and then you have the external sphincter which is under voluntary control and that's the one that you open or close depending on whether you're trying to push a stool in or out now when the rectum

fills with stool the internal sphincter relaxes to let the stool out and that's when your external sphincter is supposed to push it out but if you decide oh this isn't you know I don't like the look of this bathroom I'm going to train station I'm going to wait you're clenching when you should be

releasing and that completely confuses the sphincter so you can train yourself to hold it in and not realize you're doing that 100 percent so that creates something called reverse peristalsis where the stool is going back up in the wrong direction instead of coming out and so if you do

that often enough and often this happens in children it's more common in girls we tend to be a little bit more fastidious about where we use a bathroom if you do that often enough it means that when you actually want to have a bowel movement you can't because the sphincter is confused

like the internal sphincter relaxes but now the external sphincter is clenching my best advice for people is if you have tried everything for your constipation you did the fiber and the water and this and that and you exercise and you do all these things and nothing is working consider some of

these mind body practices whether it's cognitive behavioral therapy or it's internal by a feedback which is a kind of physical therapy find a biopheed back practitioner it could make a huge difference and the keys for me one clue is on the rectal exam i'll say oh yeah this person definitely has an

ismas and another clue is when somebody says i've done all of these things and not only is it not working it's making me more bloated because the sphincter at the very bottom is tight and so all the fiber and the water and everything is all backed up right at the back door but the door won't open so

what is the how do you know if you're bloated versus you're just gaining weight yeah that's a really challenging and sometimes uncomfortable conversation to have with people but a really useful way to know is to take a tape measure and measure right around your waist generally just around your

belly button in the morning and at night every day for about a week if there is a lot of variation in that number that's likely bloat because it bloating ebbs and flows and it's usually gas but it can also be liquid and solid if it is belly fat that number typically won't vary by more than an inch

and sometimes people come and they have an apple shape skinny legs big belly and they think they're bloated and on exam i can also tell because fat feels different yeah and when you ascultate and you you know you procrastent tap and you ascultate and listen i can tell fat from

from gas but if somebody's out there and they're not at the doctor measuring the waist and seeing if it ebbs and flows and people send me pictures and typically it's fat it's flat to fat from morning to night so they're flat in the morning and then they send me pictures at the end of the day

and they're super bloated what are some surprising foods that cause bloat that we might not know cause bloat yogurt yogurt yogurt because somewhere between 60 and 70 percent of the world's population is lactose intolerant and some people know it because i have really smelly gas and you know it's

immediate but many of us lose our ability to digest dairy over time because you know we're not baby cows so we're not willing meant to be or designed to be drinking this the lactase enzyme is along the brush border in the small intestine and and if you have an acute infection that can knock

it off and you lose it and just as we age over time so people might have tolerated dairy really well and now they're not or their dairy would mostly be cheese and yogurt and things that don't have as much lactose they're not drinking big cups of milk but dairy is one that a lot of people think of

as a health food and it can be right it's fermented food and so on but so often people are not tolerating the dairy and so they're having all this yogurt every day it's a convenient quick portable delicious source of protein so many of my patients i'll see some form of dairy either

yogurt or cottage cheese or trying to get their protein up every day and we get rid of that things improve a lot so that's something to and not for everyone but for a lot of people it's dairy are there some surprising everyday non food things that can cause you to be bloated?

yes there are one of the things to remember with bloating i mean we think about the GI tract and elimination and stool and liquid and gas but it's also our lymphatic system and our lymphatic system is like a fluid that bathes ourselves and it has to drain and exercises what stimulates lymphatic flow so if you're sitting for a long time and you may notice it just if you're sitting

for a long time your feet swell yeah why do you feet swell? i don't know because the venous flow the veins are occluded because you're sitting and there's pressure on the veins and the lymphatics don't move as much so moving around exercise really important for lymphatic flow really important

for de-bloting and then things like salt in the food alcohol and alcohols have big one because it irritates the gut that can lead to inflammation that can lead to fluid retention it also dehydrates us and then that causes fluid to shift and puffiness things like that but exercises another big one

for bloating when somebody comes and sees you doctor Robin and they just are really really bloated and it's not a big serious issue it is something that they're experiencing is there like kind of like a step-by-step protocol that you're like do this and do this and you should be feeling relief

in a matter of days i love putting people on a liquid diet for a couple days and using some magnesium citrate now i want to say with the magnesium citrate in the liquid the bottle you got to make sure there's no kidney disease and other things going on but let's say this is a typical healthy person

they went on vacation they oversported themselves in the words of my mother-in-law they ate a little too much a triangle too much they you know the most of us come back from vacation feeling a little constipated why is it it's because we've just been like whoo it's because we've been who and also

if we've crossed time zones that we often feel jet lag in our gut it slows down and also because our GI tract is a creature of habit so you know now you're in a strange bathroom somewhere and so our bottles get a little shy when we're traveling so my favorite thing in that situation is to put them

on two days of a clear liquid diet which could be broth and tea and green juice as opposed to smoothie and do that for a couple days and a little bit of liquid magnesium citrate at night not too much we don't want to do that things like a teaspoon that no no no the typical bottle of

magnesium citrate is about soda bottle so maybe a quarter of that a quarter of a quarter of that so like a cup okay of the liquid magnesium citrate make sure if you haven't taken that that you know where the bathroom is because magnesium citrate for some people it will work overnight and for

some people it could work like right now yeah so I like that because again the stimulant laxatives that have sena things like that those are really hard on the colon colon can become dependent some of them have an impact on the microbiome that isn't great the liquid diet you know

that is a great way to sort of reset to decompress most of the time when your colon is uncomfortable stop eating liquids it works great and you know you see with animals in the wild when they're sick they stop eating you won't see a dog who picked up a parasite chowing down on their food in fact

that's often how we know they're sick like in addition to the fact that we're looking at their stool they're not eating so that is still really helpful what we call NPO nothing per or I'm nothing by mouth and it doesn't have to be that extreme but going to liquids and eating less to allow

whatever it is to come out and that could be true even for something that's infectious if you have a mild case of infectious diarrhea a foodborne illness and your GI tract is trying to expel that and you're having diarrhea and you're vomiting and it's trying to eliminate it don't go

adding a whole bunch of food on top of that right and make it harder if your GI tract wants to empty let it empty get it all out and then start again so that's my my favorite thing is just to do a little mini cleanse how does stress impact are good stresses has a huge impact on our GI tract so we

talked about the gut brain connection and the neurotransmitters etc but stress triggers are sympathetic nervous system and that's our fight or flight a parasympathetic nervous system is our chill out rest and digest so if you think about having to you know get away from the tiger that's chasing you

you need the blood flow to go to your brain and the large muscles in your body your quadriceps your hamstrings so that you can run and get away from danger digestion itself is a very active process it takes a lot of enzymatic activity a lot of blood flow so when you are stressed all the resources

I are diverted away from your GI tract and so stress can really impact digestion negatively because it will affect not just the way the digestive enzymes are secreted it can decrease acid secretion it can decrease other digestive enzymes secretion but we know stress can also increase

the population of unhealthy microbes there was a famous experiment that was done in college students and it found that during finals certain more pathogenic bacteria could increase a thousand fold in an hour just stop multiplying and multiplying and you think about when college students

are stressed they're not sleeping they're not eating well they're over caffeinated and now their microbiome is out of whack so stress has a really profound impact the question comes up a lot male with people who have irritable bowel syndrome particularly folks where there hasn't been one or two

more specific causes found and they want to know well is stress causing this what I find in the GI tract is stress isn't usually the entire reason but it can be a really major contributing factor what are symptoms that indicate that there may be something more serious going on with your

got Dr. Robin red flags in the GI tract are really important and those would include things like blood in the stool weight loss vomiting abdominal pain not like a little discomfort but you know like oh that really hurt those are the things on relenting nausea those are the things that

I would say get the to a gastroenterologist and and quickly for those things Dr. Robin you have this 10 day plan for a better gut and you call it the gut bliss method will you walk us through it yeah I call it the gut bliss method and it consists of removing

replacing and restoring so the first part is to remove foods practices medications that are potentially harmful to your diet so that would be things like ultra processed foods alcohol non-striol anti-inflammatory drugs and excessive antibiotics and for practices it may be something

as simple as not taking enough time to have a bowel movement so removing those things and the idea behind that is kind of like the bathtub if you're going to fill the bathtub you got to make sure the stoppers in you don't want to be trying to fill a bathtub with a stopper out

because you're eating foods taking medications that are still causing a problem so that's removed replace is trying to add in those extra healthy bacteria not through a probiotic primarily but through exposure to nature through fermented foods that we talked about the powerhouse combination

of pre pro and postbiotics and those sorts of really healthy high fiber and fermented foods to replace the gut bacteria and then the restore is how do you restore overall health and a lot of that focuses on my my body practices on getting outside on getting quiet reducing stress and of

course hydration is a big part of it so it's simple it's stuff that anybody can do it's not expensive I mean you need access to some good food and you need to actually eat it but what I find whether I'm seeing a patient who has complicated Crohn's disease or somebody who's just a little

bloated it is incredible how much of a difference these basic principles make and I came up with them over it's been a couple decades of practice and not to say that some of the fans your things don't play a role also right but what I find the majority of the time it's really getting people to pay

attention to these foundational things that they can do these are not things that require gastroenterologists I mean you may need to go to the gastroenterologist of the evaluation for sure particularly if you have alarm symptoms but these are things that anybody can build into their everyday routine and I know that it you know it doesn't sound super sexy well where's the fancy you know magical food and supplement but believe me when I tell you mal I have done thousands of colonoscopy seen

thousands of patients in the 30 plus years since I graduated from medical school and these are the things that make a difference and the beautiful thing is you can see a difference quickly you may not be able to reverse your own immune disease quickly if that's part of the goal but in terms of

that tangible return on investment that your gut is going to give you when you sit down and you have that stool nirvana for the first time and you're like damn is this what it's supposed to feel like like I just detoxed in the most profound way I freaking love you I feel so smart and I literally

want to go to the bathroom and just like enjoy having a poo I would love Dr. Robin for you to talk directly to the person listening because you have been so generous and have poured into us there was so much that you taught us that you equipped us to be able to do if there was one thing that you

really want them to remember that they walk away and that they implement today what would that be eat more plants eat more plants you don't have to be vegan or vegetarian or any of it but plant fiber is the most important food for I've got microbiome it doesn't mean they're not

other things that aren't helpful and it doesn't mean the other stuff you're eating is bad but we have to feed our microbiome we have to nourish a nurtrit and we do that with plant fiber whether it's just a carrot steak as you're going out the door an apple that you throw in your bag

or it's more complicated you know lentil bowl eat more plants you know Dr. Robin I often remind everyone that some of the best people that you will meet you haven't met yet and I just love you I just love you literally walked into my life and we are going to be life

long friends and for the record you are ready super smart before I walked in here you already knew so much stuff people need to understand how their body works we're kind of alienated from our body and we're really alienated from our gut we don't even want to look in the toilet

I'm like how can you not look in the toilet it's like tea leaves like it's telling you something this is really important evidence and feedback like you can't just flush it and ignore it and we do that because we still have this sort of Victorian sensibility about cleanliness and stool

and it's dirty and so really understanding how this stuff works and for me helping people to understand and this was really the focus of the last book the antiviral gut that yes our gut is a digestive organ and digestion is really important but our gut is also a defensive organ

stomach acid isn't just there to digest food it also kills pathogens our gut lining literally protects us from pathogens so that bacteria and viruses can't penetrate and get into our bloodstream and travel to the rest of our body our stool eliminates not just waste matter but toxins so there's

a huge defensive element to our gut and if we want to stay healthy we got to keep these defenses going we got to protect these defenses and understand them so I'm so grateful to have a chance to come on and explain all this stuff I'm so grateful that you're here and so the the person that was

listening to us didn't just feel smarter they felt seen they now understand themselves and more importantly you know what to do and you know why this can work and why you're it matters and that means somebody's going to try it and the simplicity of it is also something that I really

love because let's face it we're all busy if you can't fit it into your already crazy busy life you're not doing it if you can't remember it when you stop listening to the two of us you're not going to be able to do it if you can't share it with your friend who has irritable bowel syndrome or

your you know son or daughter or your husband who has a problem with constipation if you can't remember what to tell them and why it matters you're not going to be able to help them absolutely and so I so appreciate spending this time with you I would sit next to you in a public bathroom

in open stalls and shit chat all day and so thank you what are your parting words I want people to remember that when they have these symptoms in the GI tract of bloating and constipation and heartburn so often these are not illnesses that are just falling out of the sky

this is your gut trying to communicate with you it is knock knock in the case of heartburn why did you have that poor-to-house stake at 11 o'clock last night and the two glasses are red wine you should have that at 1 o'clock how to salad at night so it is your GI tract giving you

feedback why is it giving you feedback to keep you alive to keep you healthy to protect you to try and prevent you from doing it again but what do we do we don't listen we just block acid and keep on going now there are of course these alarm signs right blood and severe pain and so on

but most of the symptoms a common symptoms indigestion the constipation the bloat these things it is your GI tract saying knock knock and trying to communicate with you and my whole goal is to translate the stuff to basically teach people gut language let me tell you what your

GI tract is saying and how you can respond and once people do that they don't need me and that's a goal right I'm superfluous I'll just see what the farm is market hey what's up or a public bathroom you should not if somebody is continuing to come and see me year after year after

year aside from chronic autoimmune diseases it means I'm failing I'm not doing my job if I was seeing you for constipation 10 years ago and you're still constipated you should fire me because I needed to have given you the tools I needed to have translated for you so that you now

speak gut ease and you understand and you know exactly what to do doctor Robin thank you thank you thank you and thank you for tuning and for sharing this I know you're going to share this was so many people in your life didn't you freaking love her and for the record I would be next to you

in a public bathroom stall to talking off my like whatever with you because I love you I believe in you and what I'm so excited about is you now have world class medical facts and understanding from literally the number one expert on this so you can empower yourself from the inside out to

activate the natural intelligence of your body and you now know all the health implications and how positive it is so go do it share this episode please and I can't wait to see you again soon and three two one action I love it when she says that I already feel like you're my new best friend

I already feel like you're my new best friend I'm 100% because there's we're going to talk for like five fucking out of flight yes and pathetic oh wow starting today that will help you oh my god sorry oh shit okay I gotta go back up I

didn't realize that was okay so you're fucking amazing oh my god you guys wow oh and one more thing and no this is not a blooper this is the legal language you know what the lawyers write and what I need to read to you this podcast is presented solely for educational

and entertainment purposes I'm just your friend I am not a licensed therapist and this podcast is not intended as a substitute for the advice of a physician professional coach psychotherapist or other qualified professional got it good I'll see you in the next episode stitcher