In this week's webinar, Dr. Klaper, Dr. Miller, and Dr. Marbas answer all your questions about gut health.
Questions Answered
- (00:38) – Dr. Miller on why Gut Health is important.
- (05:37) – Dr. Klaper on the evolution of Gut Health.
- (15:33) – What about excessive gas / flatulence?
- (22:52) – Where is serotonin produced?
- (23:41) – What can someone do about bloating?
- (28:21) – What damages our gut, and microbiome?
- (31:37) – What are the side effects of proton pump inhibitors and these anti-acid medications?
- (40:59) – Does apple cider vinegar help with digestion?
- (45:12) – Does the microbiome impact heart health?
- (47:46) – How does gut health impact Osteoporosis?
- (50:08) – Can a plant-based diet help with PCOS?
- (52:41) – What about having low B12?
- (55:14) – Gut Health essentials – Dr. Klaper and Dr. Miller
Complete Transcript
Narrator
(0:07)
We are making plant-based lifestyle medicine available to everyone who desires it. With telemedicine, we are removing barriers that prevent many people from accessing this type of care. Lifestyle medicine promotes healthy behaviors, and when adopted, individuals can expect improvement and in many cases, the reversal of the chronic disease.
Dr. Laurie Marbas
(0:29)
Today we were just kind of mentioning maybe talking about Gut Health and would either one of you, Dr. Klaper, Dr. Miller, like to start that conversation?
Dr. Chris Miller
(0:38)
The topic of Gut Health kind of came up today because so many of our patients are struggling with it. It is one thing when people are switching over to a plant-based diet and they will either have it previously or it will be something that is accompanying them when they come over to the diet. There is so many different types of good health. We are talking about things like heartburn. This is so common that some people do not even report it to the doctor and they go see it. But things like heartburn, things like gas and bloating after eating foods, excessive gas and bloating, more than just a little bit where they are actually uncomfortable, loose stools and they would like to see or constipated where they are hard and they are having to push it out a little bit more than they should or they are not going every day, not going easily. These things are actually seen common. Then there is a little more specific things that we are seeing now such as food sensitivities, which these never happened years and years ago, but now certain foods may be causing people to not feel well. Maybe they are getting headaches, maybe they are getting joint pains. Food sensitivities is another thing that we are seeing. I just have been studying and reading a lot lately about this and I am seeing a lot of patients and so I just wanted to say one quick thing to tie all of that in together with one concept. That is the concept of the gut microbiome.
Those are the bacteria that we think there is some are like 39 trillion bacteria now in the gut. When those are out of balance, when there is such a mixture between bacteria and parasites and viruses and archaea – is out the last group that group is there? – But all these different species are in our guts and they are in harmony. We want to have lots and lots and lots of diversity and we know from studies that people with the most diversity are the healthiest. They do not have these autoimmune conditions and inflammatory conditions and even things like cancer and heart disease and nerve degenerative diseases. I mean, it is crazy the link how many things are related to this microbiome, these bacteria. They do so much for us from helping us digest her food to preventing that gas and bloating, protecting the bowel wall for us. They detoxify and they make these metabolites, these short chain fatty acids and these other materials that go all throughout our body and reduce inflammation, help heal us, keep us healthy and in harmony or do the opposite and they cause us to have inflammation and all these other chronic issues that we are feeling. I think so much of what we are seeing is due to some sort of that loss of this harmony of the microbiome. There is so many more factors that are at play. I just way over simplified this but I just kind of wanted to talk about that today given this broad concept.
When we can get a diverse bacteria to count in whole species, I should say – I broaden that – in our guts and when they are working in harmony the way they are supposed to be working with us, us with them and doing their job properly, we feel good and disease starts to melt away and all of those gut issues start to melt away. From heartburn to the gas imploding to diarrhea to constipation to the food sensitivities. They will actually disappear, allergies, and then of all these stomach issues start to go away. That is sort of something I worked on with all my patients. I have that in my mind as we are working with them together. We are going to talk about how you do that and I am going to kind of leave it at that and let Dr. Klaper kind of take over and talk about what people want to talk about. I will say that the way that we do this is through diet and lifestyle changes. Things like fiber and prebiotic foods, which we can do talk a lot more about all of that type of thing, and polyphenols which are a clacid of antioxidants which actually do not get absorbed, do not get digested and they are about ninety or ninety-five percent is in our colon and help us also try and promote those anti-inflammatory bacteria to thrive. We get this healthy beneficial bacteria and we do good things. That is what we are working on with that between our diets and things like stress and sleep and exercise and being outdoors and in nature and dirt and all these good things change that microbiome and keep us healthy and humming. Anyway, I just wanted to touch on that. That is something I always think about with my patients. That is my introduction to Gut Health in a nutshell.
Dr. Marbas
(5:22)
Excellent. Dr. Klaper?
Dr. Klaper
(5:26)
Well, what is more, is there left to say after that explanation? Good, that was really that is a lot of basics.
Dr. Marbas
(5:33)
Absolutely.
Dr. Klaper
(5:35)
So well done.
Dr. Miller
(5:36)
Thank you.
Dr. Klaper
(5:37)
I am going to start literally up at the beginning, at the top. It is not too much of a stretch if people believe in evolution at all to realize that we Homo Sapien creatures here. We came up through the Simian through the Ape line of creatures on this planet. For the past 20 million years, they have been here and you look back at the fossil records and even the recent hominid records. It is clear we are this line, we are plant-eating hominids. We are monkeys and apes that spent all day putting herbage down our gullet here. There are gorillas and bonobo cousins are up in the trees eating leaves and fruits today. Since we have basically the same digestive system that they do there large and the same digestive system and it us with our fingers on our hands instead of claws and our flat grinding molar teeth to chew in a rotary motion and we have saliva that has starch digesting enzymes and the signs are clear that we are plant-eating hominids as well. Our digestive system is really set up for that. We fell like we are designed for taking whole plant food, chewing them up really well and as it passes through our stomach and goes to our pancreas and liver, the enzymes are put and digest starches and proteins and fats and it is really well set up for digesting high fiber plant foods as opposed to your house cat which is set up for digesting animal flesh.
As the food mass goes down the small intestine 22 feet of a muscular tube that is churning and secreting enzymes there, the small intestine is lined with glands that weep cascades of liquid enzymes, of proteases, for proteins, and analyzes for starches in the intestinal lipase is all these weeps off the walls of the intestine get mixed in through the muscular action into the food mass. After 22 feet of this type of digestive action, the food is very well digested by the time the nutrients in the corn and the beans, etcetera, are broken down into their individual amino acids or individual vitamins and minerals and they are easily absorbed. They are shipped up to the liver where your liver reacidembles them as your proteins. It is a really beautiful mechanism. Then by the time it gets to the end of the small intestine about then the large intestine, there should not be much left besides fiber and water. The fibers by definition the indigestible part of the plant foods and waters and it is mostly what the whole foods are made up with. Into the colon, this food mass goes and wonderful things happen in there as Dr. Miller which is mentioning the microbes are not only fed by the carbohydrates and the fiber but they in turn digest those carbohydrates into important molecules like butyrate that heal the wall of the gut.
It finally results in normal bowel function where the happy healthy hominid who is eating these high fiber plant foods passes these large soft bulky stools, which are really easy for the colon to get a purchase on and push out. The gorillas said do not get hemorrhoids, diverticulosis. They pushed those stools out very easily. In all this is a big validation that a whole food plant-based diet really is what we should be eating. When we violate natural law, when we deviate from that and we start eating the fond of white flour products and the sugary drinks and certainly animal flesh and the oils, these things have no fiber and then they do not have the vitamins and minerals of the whole plant foods do. Strange things start happening in the gut. The digestion does not work, you start summoning up bacteria that are harmful. When Dr. Miller used the term prebiotic, it is a really powerful concept and basically it is what that word says s that the food we eat determines the microbes that live in our gut. How can it do that? Well, the microbes are already down there. The good guys are already down there. The bad guys are already down there. We all have a whole panoply of different organisms down there. The food that comes down is like the orchestra conductor in a symphony and your instructor brings up the woodwinds and tones down the bracid a little bit. Well, that is what the food does to your microbes. If you eat a bunch of sugar in your diet, you are going to sum it up the sugar eating microbes. You eat a bunch of meat, you are going to sum it up carnitine eating microbes and they got their own problems. You eat those lovely high fibers and whole plant foods and you summon up these wonderful bacterias and others that are anti-inflammatory, they are stabilizing and they promote colon health and they promote your general health because the more we look at the microbes the more we learn about them.
Their job is not over I just think fiber in the gut. We are seeing how much these microbes influence us. One way is that their waste products, so to speak, are molecules, more epinephrine and serotonin, and dopamine. These are neurotransmitters that get into our brain now, they ride up through our circulation into our vagus nerve and they change our mood, they change our perception, they change our cravings. These microbes really are a
copilot with us as we go through our lives. It is another organ altogether. There is almost another being, it is alive and it responds to our food. You want to keep it your ally, you want to keep it healthy. It is a guest in your home or your almost a guest in its home, it would seem. You want to work with this partner and you feed it good things, you put high-quality gasoline in your car, you get the performance, while you put high-quality high-fiber plant foods down your gut, you get a microbiome that protects you and aids your immune system. It is all goes back to, again, the natural way of things. I never had a gorilla or a bonobo in the office saying, “Doc, I cannot stop eating these cheeseburgers.” They know what to eat. They are plant-eating creatures. We need to follow their example. Eat good food and your gut takes care of itself. All the problems we get, the diverticulitis, the and the gas and the chronics disease, and the colitis and the reflex. These are from putting their own fuel down there. This is an unhappy gut that is waving a flag through these symptoms saying, “Wrong fuel! Wrong fuel!” Put the right field down there and most of these conditions go away. Yeah, everybody has some gas, everybody who eats a high-carbohydrate diet is going to produce some carbon dioxide nothing.
But do not let that put you off unless it is just outrageously uncomfortable for you. People often have more gas production when they changed to a high-fiber diet. But as it said in ancient literature, this too shall pass and it does. As the weeks go by, people generally have fewer problems with guts. When we say whole food plant-based, it is for real, especially when it comes down to your gut and that is the recipe for keeping everything happy from your intestines to your microbiome. In all the rest, you are going to hear this restless hours variations on the theme I would imagine.
Dr. Marbas
(14:11)
Absolutely. Wow. Between Dr. Miller and Dr. Klaper, there is not much left to say. I think you guys just even listen to that should be well prepared. There are some specific questions we have been getting in, we have got quite a few actually. One of them you did address, Dr. Klaper showing that your mood can benefit from eating a whole food plant-based diet given that so many of those good feeling hormones are made in the gut upwards of ninety percent and all these amazing neural connections between the brain and the gut like you said the second brain second, organ, a different organ in and of itself. One of the other questions, I am just going to try and lump the sum of these together. One in particular Marion I think is from the UK, she says she has been “Having issues from increased gas and bloating and recently my diet choices have been high-fiber low fat for decades, but then we went whole food plant-based not perfect but ninety percent this year. I did not expect to have more discomfort than my husband who feels better or expects the occasional episode of bloating discomfort that I have been having would disappear to become a daily issue.” Many times people will have those situations when they first transition. Do you have any suggestions or thoughts on why that may be occurring for her? I am not sure how long she has been doing that but go ahead.
Dr. Klaper
(15:27)
Dr. Miller, how do you handle your patients who have excessive flatus.
Dr. Miller
(15:33)
Yes, it is common when you are transferring over. We can take a look at what you are eating specifically. You can kind of slow it down if it really becomes intolerable for you. Things like dark-colored beans are going to cause a little more gas and bloating than light-colored beans and certain foods you can kind of limit the very beginning or cook a little bit more at the beginning and to kind of easy you in. When it is in a toggle for people, I helped them kind of make some adjustments to slow it down. For the majority of people though as they are transitioning, we just kind of go for it and write it out and it gets better. I do have some that it is really uncomfortable and they have to be at work or there. It is just not going right for them. We can definitely slow that down by slowing down the legumes and being a little bit mindful and watching when they seem to feel like they get the most in certain vegetables that might cause a little more gas and bloating. Like the cruciferous which we want to be eating but if we eat a significant amount raw such as broccoli or cauliflower or cabbage, that might cause more gas so we made you some raw, some cooked. Be mindful that at the beginning but we really do want to be developing the right bacteria and microbiome. That gas and bloating is a sign that we are making the shift. We are going to try to somehow work through that. That is what I usually encourage with that.
Dr. Klaper
(16:59)
Right. This is by far the most common complaint that I get about people who either on a whole food plant-based or transition to it. We can throw out some strategies here. But at the risk of being a little indiscreet here. The truth of it is all mammals fart and the horses do it, the cows do it, all plant-eating creatures as the microbes in the gut digest especially the carbohydrate, you are going to generate carbon dioxide, you are going to generate methane, maybe hydrogen sulfide and depending on which microbes you have got down there and how much the minimal sugars you are putting down is going to determine how much gas gets produced. It is not a disease the liver died of it. It is socially awkward bending can feel a little uncomfortable, but it is just gas. What can be done about it? Well, one thing to understand it better is that there is a lag period that you have to take into account. If you eat a bunch of white potatoes and bread and other flour products. At the farmers market, you got a 10-pound bag of potatoes and for the next few nights, you ate lots of potatoes and make some gravy indulge in bread and such. Well, now you put down a fair amount of pretty easily fermentable carbohydrates. Well, what is going to happen? Well, the microbes down there that live on those kinds of organisms are going to increase their numbers, that live in those kinds of sugars. Now you have got that increased gang there waiting for the next meal to come down here. Now though, they might also some of those microbes may have the ability to put a little extra methane, electrolytes and so fight. Down comes the next, you went to the Chinese restaurant and here comes some white rice. Well, it turns out that those microbes you summoned up are particularly adept at metabolizing the carbohydrates in white rice. You get an extra big gas production.
Again, it was set up by the meal you ate a few days ago. Why am I having this gas? Well, as I say, there is a four-five day lag and as the microbes change then depends what you are putting down there afterward. If the combinations are not fortuitous then you wind up with a lot of gas. What can you do? How can you break this up? Dr. Miller hinted at that. For a few days, four or five days. We want to do change the microbial population in the gut. For four or five days, you might want to yank out a lot of the easily fermentable starches and the cruciferous vegetables. In other words, you cook up a big pot of vegetable soup and steam up some non-cruciferous vegetables and carrots and charred and have some papayas for desert. Again as a medicinal whole mini fast, if you will. For four or five days is really changes up the food stream. You are going to change the microbe significantly downstream there. Some people if you are experienced at can do a whole three-day water fast or four-day water fast, which will change the microbes as well. Give your body a break from the fermentable sugars. Then start introducing the foods. A nice way to come back from that is green smoothies or you pack a blender full of greens and let them up a little bit of almond milk and flax seeds and maybe a banana for sweetness there and just sip a smoothie all day for a day, that will change the microbes in your gut as well. Then slowly go back to the same diet. You are going to have a different set of microbes there, would have set off with a brief course of five or ten-day course of probiotics during this time helped change. That is another strategy you can try.
Again, working in True North Health Center where we are doing water fasting and five seven day water fast, a lot of people have a lot less flatulence after that because it really does change the microbes. It is a delicate dance. You got to know to get to know your colon and your particular microbes down there and which foods feed them and which do no. After a while, you all really understand too. When I had the soup in the chart, you did not have much gas. Okay. Then you can start as a baseline there and start adding foods in and keep track of which ones the next to give you more gas or less gas. There are ways to get out the magnifiers and look at your diet and how things are really affecting the gas production. It can be frustrating and a little embarrassing but again, it is just gas and it shall pass it. It goes in cycles. Again depending on the microbes, I will have a really severe issue for a few weeks or a month or two, and then it goes weighing only think about it again for months and months, and then it can come back depending on your food choices. It is like the tides, it comes and goes. Again, never wrote excessive flatulence on a death certificate. Do not worry about that.
Dr. Marbas
(22:48)
That would be a new one.
Dr. Klaper
(22:50)
It would, yes.
Dr. Marbas
(22:52)
Just to kind of go back also Clair, it is a pretty simple question. “Is serotonin produced by the microbiome or by your body primed by the microbiome?” It is the second, the latter. You are not all in the gut but ninety percent are still of it and it is made by certain types of cells in the gut and those microbiomes are communicating to those cells and influencing how much we make. I hope that helps. It is a pretty straightforward answer but just kind of going where we were there have been several questions people have here. For example, one person mentioned that she started having trouble with leafy greens after a heavy round of antibiotics and steroids. Now it has been going on for two to three years. Then some other folks had a different question as well. Very similar. She is saying that it is the bloating. That is the most discomfort, not so much the gas but the bloating and the discomfort that will keep her up at night. Any suggestions or comments there? Someone after antibiotics or steroids that may have caused some disruption of the microbiome in the population there and then the consequential bloating that effects.
Dr. Miller
(24:03)
Yeah, that definitely happens. First of all, sorry about that discomfort you are having because that can be really uncomfortable for sure. But it goes back to the microbiome being out of balance. Those antibiotics are going to be a big deal. Taking antibiotics you have now destroyed the good bacteria that are kind of protecting it and keeping it all in balance. Remember it is that fine balance that is so important and then when that gets disrupted that is where we get in trouble. Now some of the more gas-producing ones can kind of take action. What also happens with things like antibiotics, of course, but also with things like proton pump inhibitors which decreases the stomach acid, it can happen people with diabetes or people for whatever reason they are not getting the peristalsis, people's chronic constipation, people not eating fiber, people eating in an inflammatory diet which is most of us as we are growing up in America, it seems. With all those diets, the bacteria that are supposed to be in the colon doing their happy good things for us, they migrate up to the small intestine. They are right there. After the food bowl gets through the stomach, it is right there. What happens is they start fermenting the carbohydrates from the foods. Someone will feel excessive gas and bloating and it tends to be upper, it can be right after a meal to 30 minutes afterward and it is very uncomfortable. That is what Dr. Klaper was talking about for people who are experiencing that and it can be pretty severe. We kind of get this a lot by history hearing what is going on with patients or a person, we can start to figure out exactly the reason but if that tends to be the reason, that is where we really do want to slow down the fiber for a little bit. Why? That is the healing best thing you want to do. Continue those fibers, continue those bacteria to thrive in that small intestine where they are not supposed to be, at least not so many of them.
We do have protocols and we work with patients so if you are having a hard time, you can work with one of us. We will be happy to help you ease this out and improve it but it has to do a lot with cooking the food initially, freezing it or blending it, breaking down some of that protein, and cutting out some of the high carbohydrate foods like legumes initially and gluten initially like Dr. Klaper had referred to the same similar idea to like that or same idea probably. We cut those out initially and we very quickly are adjusting the diets. We want to bring them back in but we do it in a certain order. It is pretty specific though. It can be so not too much fat at the beginning that can also be irritating but then we slowly bringing the flax seeds. It is like a stepwise but it is happening relatively quickly because we do not want you eliminating these foods for too long. Then we start bringing them raw. We have stuff like that. That can be helpful for you. I would say initially if you do not work with us. To start with things cooking it initially and try not to eat all the time. No cut out snacking. One other thing I found that really help my patients is intermittent fasting. If you are not up for doing full water fast which is wonderful and life preserves, I have done it myself at True North actually, but by just two intermittent fasting so the time or I should say the time-restricted eating. Giving yourself a long overnight period to kind of reset that microbiome, that seems to really help people's gas and bloating as well.
Maybe having breakfast and lunch at early dinner or even just a breakfast and lunch or brunch and a dinner type thing, two meals, and giving yourself that long period of overnight fasting just sipping water. It kind of resets the microbiome and calms things down a little bit. Then each day you keep working at it and we keep progressing and get you rid of. That is what I do with my patients, kind of monitoring them, helping them through that, and get them over the hump where now we have a healthy happy harmony microbiome again.
Dr. Klaper
(28:12)
Now, I will just put it out there. The modern life is an assault on our gut. You turn on the tap to get water for making soup and there is chlorine in the drinking water. It is there to kill bacteria. People who drink coffee and tea, these plants are not making the peppermint plant. It is not making that peppermint oil for your afternoon herbal tea, which is an antibacterial oil that the plant is making to kill microbes that plants get infections too. Then they make these oils to prevent the bacteria from invading their leaves and stems. Well, when you make a tea of it and drink it, not saying that peppermint tea is evil but to be drinking these herbal teas all day is going to have an effect down in your gut. Coffee itself, the coffee oils have an antibacterial action to them. If you are a cola drinker, the phosphoric acid and cola drinks that give the cola drinks down your tongue is just phosphoric acid, it kills bad bacteria. If you are still eating chicken and factory farm animals, you are eating antibiotics because they feed those animals antibiotics. It is in the chicken, it is in the farm salmon, they are full of antibiotics. Then, of course, the antibiotics that people get from their doctors for running noses and colds and things that they do not really should be taking antibiotics for.
Modern life is not friendly to your gut flora and now you want to avoid those toxins as much as you can. Also, a lot of the distension he has to do with all the air that we swallow. Every time you swallow to take these foods, air goes down into our stomach. You swallow 20 times during a meal, you got a half a pint of air down your stomach by the end of the meal. Well, once it is in your stomach, they are going to go over two places, going to go up, going to go down. You either release it from above discreetly with the belch or it is going to go down and make you feel bloated and gacidy. You want to minimize the air swallowed. How do you do that? There is air in the food, in a fork full of air between the grains of rice and a fork full of corn kernels which air between the. Yeah, fork full of those salad, there is air between the lettuce leaves before food pack air down the fruits. There is air the food. We all stress how important it is to chew our food well to break up the cell walls so we can absorb the nutrients in the food. Well, another advantage of chewing your food to cream, is that it drives the air out of the food you are to swallow a lot of those air. If you slow down and I tell folks to put a fork full of salad on your mouth, put the fork down make salad puree in your mouth before you swallow it really chew it to a. You will not only get more nutrients absorbed from that, but you will swallow a lot less air, and you have a lot less bloating. We are eating so fast and we are talking even shovel it in. Slow down, and especially these days we have got a little extra time. Chew your food. Your mother was right, you chew your food and you will have a lot less bloated if you do that as well. Be kind to the microbiome in your gut flora with every mouthful. Dr. Marbas?
Dr. Marbas
(31:37)
Yes. Again, bows on both those answers for task six. Moving right along, this is a pretty common thing of one of the most highly used medications are these proton pump inhibitors and these anti-acid medications. There was a question about what are the common side effects of taking antacid prescription medicine long term. There are more recent concerns with encouraging things. People are like, “Oh, it is fine to take those long term antacid,” but it is actually not. You have increased risk for fractures, you have even linked pneumonia, certain c-diff or clustered in infections, like diarrhea that can be very serious, low magnesium, low B12, kidney disease, all these things, memory loss. Those are not healthy long-term. Do you have any suggestions for people who are really dealing even if they are on a plant-based diet with heartburn? Specifically, what would you suggest that they have been on the plant-based diet and they are still struggling, any thoughts or questions or suggestions?
Dr. Klaper
(32:39)
I will take that one if you do not mind. Absolutely, very important topic. These proton pump inhibitors, they work and they will turn off your acids for good 24 hours. They have stomach acid there for a reason as Dr. Marbas was implying. Mother nature knows what she is doing. You need an answer to absorb iron, you need to absorb vitamin B12, you need to kill bacteria that would go down your gut and cause problems, you need to absorb it, to digest protein. That acid is supposed to be there. It is okay to turn it off for a few weeks if you are healing, I guess try to sort of an upset stomach, but you do not want to turn off your acid month after month after month. You start causing all sorts of just harmony and downstream from microbes in organs expecting this stomach acid to come down. She said it can set you up from everything, from iron deficiency, anemia, to osteoporosis, and calcium malabsorption, to B12 deficiency. You never want to use the drugs for more than six weeks in total. Just be aware they do not put that on the label but they darn know should. That is said what do you do if you got some heartburn? A couple of things, the heartburn is usually from the stomach acid rolling up into your lower esophagus. That is going to happen more when you eat a big meal with lots of proteins, as the proteins sum up lots of acids, the big acid of the meal distends the sphincter down at the upper part of your stomach and then you go lay down. Well, that is a recipe for that just rolling up in your stomach. If you are troubled with acid reflux, save your big meals to herb for earlier in the day when you are still upright and walking around so it has a chance to slither out the bottom of the stomach where it belongs. Do not eat a big meal and lay down.
If this is really chronic, you can elevate the head legs of your bed, it raised and get a couple of four-inch blocks of wood, 6 inches at the most, put them under the head legs of the bed more than 6 inches the husband starts sliding out the foot of the bed, no more than 6 inches. Seriously water does not run uphill, neither does stomach acid. Raise the head of the bed, gravity will help keep the acid in your stomach all night. People say, “Well, I sleep on an extra pillow.” Does not work. By 3:00 in the morning, everybody slithers out flat. You really need to elevate the head of your bed with a couple of pieces of 2×4. You can get commercial blocks off the internet. As I said, do not eat especially protein late at night. If any food makes your acid reflux worse, do not eat it. Common sense goes a long way. If and pepperoni , do not eat it. If you have had a really so you have been taking too much ibuprofen or you have really burn your stomach lining and you really do need to shut your acid off for a week or two or three. I far prefer to use these H2 inhibitors like ranitidine or famotidine that you can get over the counter at the pharmacy. They just turn your acid off for 12 hours. I recommend people take them after dinner if you had your stomach acid to help you digest dinner. At six or seven in the evening, that is when they take the famotidine. By the time you lie down at 10 o'clock at night, you should not have much acid in your stomach. You can chew up some anti-acids you have to just sum up any acids that might be down there. The will keep your stomach acid really low all night while you are sleeping, as the dawn is breaking, then that is wearing off. By the time you are up and eating again, your acid is coming back. It is not like the so long term PPI to just shut your acid off all day, day after day. Even then just use that for a few weeks. Do not you understand forever and ever either. The raiser under your bed, do not eat protein late at nights and use the H2 blocker sparingly at all if you need just some temporary relief from one of these acid reflux episodes.
Dr. Marbas
(37:05)
I would like to just mention a few other things too. I was active duty in the Air Force and deployed overseas to the Middle East. I came back with H pylori and six gastric ulcers, having significant pain heartburn that I never had before. If you are finding that these symptoms are persistent, you are having dark tarry stools, you feel like you are feeling really early meaning that you are eating and you are just like, “Well, I am just feeling full really early,” or if you are still not hungry the next day or if you are finding that it hurts to swallow or you feel like something gets stuck in your esophagus, that is really really important that you see someone locally and have someone do a stomach evaluation to look at you, maybe you need a scope. These are maybe some other things occurring like an esophageal stricture, some other things there, or if you have diabetes if you feel like sometimes your stomach does not empty well, you are. There are just some of the red flags. If you have any questions about that, we can certainly help direct you but I just wanted to point out those red flags and that could be very serious because you can have peptic ulcers and all sorts of things. Chris, did you have any other maybe homeopathic or some food suggestions or things to help people who are not in those categories of red flags but maybe might be helpful for them?
Dr. Miller
(38:14)
That is great from both of you guys, great assessment. I do not have too much more to add but I am always trying to think of why it is still going on, what is causing this? Because remember this is inflammation, something always triggers inflammation. Along with everything that they both just said, I will try to see in that individual person why they are getting that inflammation. Then we want to remove the inciting factors which like Dr. Klaper want to solve thoroughly remove those types of foods that he talked about. Also maybe pay attention to a food symptom journalists helpful what you are eating and when you get it were. Things like alcohol, things like dark chocolate is healthy and that can be some cocoa can worsen it, even green tea sometimes can worsen it in some people kind of depending things like peppermint can make the sphincter a little bit weaker. The acid then goes up into the esophagus. Paying attention to all of that, keeping a food symptom journal, and if there is someone is still having a hard time, even with all that doing the small meals, not eating late at night, drinking plenty of water, getting a little bit of exercise, a couple other things that come to mind then one is stress. Stress definitely can cause colon stress ulcers. It happens for that reason.
Again, that is that mind-gut connection. Your thoughts of stress and worry and anxiety go to your gut. It has actually been shown increased stomach acid secretion. That is one thing that I worked on with patients. Then just a couple of herbs that can be helpful while you are transitioning or if you are having a hard time. I like to use things like aloe, not the leaf that causes diarrhea, but aloe the liquid and you can just buy it as a clear liquid and it is pretty benign and you can sip that on an empty stomach before your meal. It kind of helps coat it a little bit, you can also sip something like marshmallow root tea or slippery elm tea. Both of those do the same thing, they are called and they just kind of coat stomach a little bit. That will help ease some of that acid discomfort you might be feeling. I used these with my patients in addition to the lifestyle changes that we talked about and each person is a little bit different. That is the thing. Sometimes we have to tease out a little bit what is causing it in that person, we want to make sure we are not missing anything really bad like Dr. Marbas pointed out, make sure you are not missing any of those, or if you have been told that you have erosive esophagitis or Barrett's esophagus or something like that in your history. Then we want to be more careful. For most people with some modifications diet and lifestyle, it is so important to remember that hopefully you will start to find some relief.
Dr. Marbas
(40:59)
That is great and additional question is regarding apple cider vinegar. She says is it helpful to take a teaspoon of apple cider vinegar before meals to increase stomach acidity to help digest food?
Dr. Miller
(41:15)
I find that an interesting question. I am laughing because I just worked with some out here in Southern Vermont who are lovely people, wonderful, wonderful people but some of them recommend a more meat-based diet than I do. Obviously, I recommend no meat because I am plant-based but they recommend more meat-based diet. Many other patients would come in with having quite a bit of heartburn. They were all telling them to take apple cider vinegar, which is more alkalizing and it helped with some of the extra acid production they were getting from eating that high animal protein. I had never really heard of that. I delved into it, read about it and learn the research and talk to them, find out what they are doing, talk to the patients. It really did help them, but they were eating that diet. For me with my patients, I had a totally different approach where we went off the animal protein as much as patient would agree to do for me and we worked in that direction. I did not put them on apple cider vinegar, not typically. Although I am a fan of vinegar in general in salad dressings. You are eating vinegar as part of your meal and with a symphony of all these other high-fiber foods and then removing the high protein, removing the high-fat, removing the need to secrete all that acid in your stomach and bring you back into balance. It is not something I have ever used, but I firsthand witnessed it being used and so I kind of understand it a little bit better now. I hope that helps you but feel free to add vinegar to your meals. Apple cider vinegar is wonderful for you as vinegar and all those different yummy flavor infused vinegars, but I would also caution you one thing. Apple cider vinegar, I eat it quite a bit. I use it on my salads and eat it quite a bit because I actually like the flavor of it, but it can erode your teeth. Be real careful. I have really soft bad teeth and all of a sudden went to the dentist and I had several cavities and I have not had cavities in years and I could not believe what had happened. I have been eating the extra vinegar.
What I recommend is if you do eat vinegar even on salad dressings, I do this now and the same thing with citrus who is like that but rinse your mouth with water right afterward and do not brush for at least 30 minutes to maybe not even an hour because of the enamel soft right after that. What I would do is I would eat and then brush my teeth and I was like brushing away the enamel. I learned my lesson and I teach my patients that too. Be real careful things like apple cider vinegar. Anyway, that is personal stories.
Dr. Klaper
(43:46)
Oh, well, you just heard a very important personal story from Dr. Miller. That is no joke. Tooth enamel is the hardest structure in the human body, but it will dissolve in any acid, lemon juice, apple cider vinegar, absolutely stomach acid that people reflex up. Her question about rinsing your mouth out after using it is valid, as the months go by you can really make some pits in your teeth to go through the enamel. When I first heard about apple cider vinegar, I thought, “Boy, that one is just right out of the old folk tales, nonsense category,” there is less reason to be humble here, turned out if you go to Dr. Michael Greger's nutritionfacts.org and you look up apple cider vinegar, you will see that there is quite a number of studies saying it is quite useful substance. Apparently, it helps with weight loss. It helps with digestion. I think it lowers cholesterol. It does some beneficial things in the body. To go back, it has been a few years since I read Dr. Greger's recaps there. Now, but it turns out that it is worthwhile researching. It does have some interesting nutritional properties in it. I go to nutritionfacts.org Dr. Greger's videos, you are going to learn about apple cider vinegar something to it.
Dr. Marbas
(45:12)
There is even some research to help with blood sugars. It is some interference with starches ingestion, stuff like that. Yeah, that is some great questions and great answers. We have a bunch more so here we go. There are a few, this one actually is a very good one. Does the microbiome have any negative impacts on things like heart health or causing things like osteoporosis, and I think we have alluded to that but maybe either you want to go into more specifics like TMAO production and things like that or any particulars?
Dr. Klaper
(45:43)
Absolutely. Dr. Marbas mentioned those for fateful letters – TMAO – and then so we will go back to square one the food you eat determines the microbes that live in your gut and if you are eating meat you are eating a molecule called carnitine. If you are eating eggs, you are eating molecules called choline and you eat meat and eggs most days so you are going to summon up microbes in your gut like peptostreptococcus. That is bacteria that loves eating carnitine and choline but they do not care about you, they will turn that molecule into something called trimethylamine that then goes up through your liver that oxidizes it to trimethylamine oxide. This is a molecule from hell, this drives cholesterol into the artery walls and prevents your good cholesterol from taking that cholesterol out and transporting it to the liver. The folks who eat lots of meat get high TMAO levels and that seems to be setting them up for epidemic of heart attacks, strokes, and other vascular catastrophes. The classic study that was done to illustrate the point and put a cherry on the sundae there, so to speak, is that they then gave a big T-bone steak to a couple of vegans and check their TMAO levels after they ate it, and guess what? It did not go up. Why? Because they had not cultured their population of microbes with meats on their diets. They eat plants all day and you are just not going to summon up those TMAO-generating microbes. It is another validation. We are plant-eating simians and the gorillas do not have to worry about TMAO. We really should not either if we stay on a whole food plant-based diet. That really should be a problem. There is a definite tie between the gut and your arteries and the other one was —
Dr. Marbas
(47:46)
Osteoporosis
Dr. Klaper
(47:47)
Osteoporosis. Dr. Miller, do you connections between the microbiome and osteoporosis?
Dr. Miller
(47:53)
Yes. Actually there are connections with that and it is one of the reasons why a high-fiber diet is also helpful with osteoporosis. One thing I always think about, I think about this myself, especially if my own gut and then when I work with my patients, but if you get inflammation in your gut there is so much connection everywhere in our body. Whether it is through the nervous system to attract nerves, to our brains to our hearts to our lungs. I mean, it is talking or it is through the endocrine system. It is releasing these little tiny hormones which are going somewhere and leaving messages. The whole body is in communication so inflammation in our gut is inflammation in our body. If you are eating any pro-inflammatory food at all, and even on a whole food plant-based diet, if you are eating crackers that are whole food plant-based but they are still processed, it can cause inflammation in some people or if you eat something with any added food additives or something your particular body does not like right now because your gut microbiome is a little bit out of balance so you are getting inflammation. Anytime we have this inflammatory reaction, that is where we are seeing both the nerves and the endocrine system, the hormones as well as those metabolites we have been talking about, it is going to change that as well. They are actually is directing with both like with the heart so well and the blood vessels but also with the bones and whether we get bone turnover, build bones, and then eating their certain foods and whole-food plant-based diet we really emphasize with osteoporosis. The calcium-rich foods, of course, things like legumes are associated with stronger bones, whole grain. It comes back to you if you really think about it, building that diverse microbiome and the good anti-inflammatory bacteria to have regenerated bone health, so interesting.
I mean, the microbiome is just the most amazing thing. It really blows my mind since I had become a doctor. I am not kidding you. It is crazy how powerful it is and how it affects our bodies. Get that under control and everybody is gonna be golden.
Dr. Marbas
(50:01)
Yes. It is like the new frontier of medicine, right?
Dr. Miller
(50:04)
Yeah, so crazy. Unbelievable.
D. Marbas
(50:08)
There is some additional question here but I think probably several people are dealing with. She says, “Hello. I have diabetes and PCOS. I have had fertility issues for five years. Can plant-based or any specific foods help me get rid of PCOS and help me finally conceived?” Her name is Chrissy. Chrissy, I would highly recommend you make an appointment with one of us. Yes, the foods are going to be able to help with diabetes and PCOS and potentially with the fertility issues. There may be other issues involved that would need to be investigated and ask certain questions and get your history. That is a very involved question. But these are some of our favorite patients. If you guys are looking for a plant-based doctor, you can check us out at plantbasedtelehealth.com and there is just so much to that question that I would love to dive into you. But are there any specifics besides, yes, we can help you significantly with all of that, but any particulars that you have we would like to suggest to her.
Dr. Klaper
(51:04)
Yes, we can help you significantly with all of that.
Dr. Marbas
(51:07)
It is such an involved question. There are so many fun things to go diving into that. Chrissy, please check us out.
Dr. Klaper
(51:15)
When I was a med student when I first started seeing my patient's PCOS, and I did not know what to tell these poor women. They have trouble getting pregnant. They were unhappy with her body look and they have diabetes and it is just a Dreadful predicament to find yourself in. I did not think that food had anything to do with it, turns out it has a lot to do with it. It is the major key to unlocking all those problems. There are some subtleties involved that you need, Dr. Marbas and Dr. Miller, to guide you through it. But absolutely food plays a key role in PCOS. Please work with them and you will get some significant relief of it.
Dr. Marbas
(51:55)
Not only that healthy pregnancy, as a mom and had three pregnancies myself and I did have, again one of my favorite population to work with. I have another question for you guys. I think it is probably very common as well. This person mentioned she has been supplementing with a thousand micrograms of B12 twice a week orally, and tested really low for her B12 and had to get shots weekly for one month in addition to taking 1,000 micrograms daily. What are some possibilities of testing solo while supplementing and do you have any suggestions? There are some things like intrinsic factor, but that is not usually, you are a little bit older, the populations do but you guys have any thoughts or suggestions about that?
Dr. Miller
(52:41)
I do not want anything about this person except that the B12 is low. It is a little bit hard to just start making up an answer, but I am going to just talk in general about B12. First of all, if you are going to work with one of us again, we are happy to work and delve into this with you individually, but as people get older B12 gets harder and harder to be absorbed and some people have a harder time. If people are having gut issues, I find people that have low B12. Someone with Celiac, someone with an inflammatory condition, someone with food sensitivities and excessive gas and bloating so we know that the microbiome is out of balance. They actually can tend to have low B12. People on certain medications can have low B12. That is associated too. Depending if you are taking certain medications, I would look into that. Then there are the autoimmune conditions like Laurie was talking about. The intrinsic factor has to bind to the B12 and absorbs it. Some people are not making that or they have an antibody against it. We actually do see low B12 in some people and it can take a little bit of an adjustment. For you individually, we would be happy to tease that out with you or see if we can figure that out.
Dr. Marbas
(53:52)
Absolutely.
Dr. Klaper
(53:54)
You may have spawned the population of microbes that are eating the B12. There are some microbes that actually utilize it and they might be digesting it before you get a chance or you might be drinking coffee or some herb tea or whatever that is blocking you and your ability to absorb it as well. Keep your diet really clean. Get out the junk sugars and strange stuff you might be eating. Eat a really healthy whole food plant-based diet and see if you can push any microbes that might be interfering with your absorption down at your colon where they cause any mischief there.
Dr. Marbas
(54:25)
Yeah, absolutely and I would echo that as well that there may be certain medications if you are diabetic. We said we do not know all the rest of her history metformin certain acid, blocking medication, decrease the absorption of B12. That would be something else to consider.
Also to make sure that using a really good supplement. Sometimes supplements that we buy are not actually what they are advertised. You want to make sure to go to Consumer Reports. I guess consumer lab reports, Chris, s that the one that you used to?
Dr. Miller
(54:54)
Yeah, comsumerlab.com.
Dr. Marbas
(54:56)
Yeah. Okay. They do some really independent testing on certain supplements so that might be very helpful too. We have a few minutes left and we have some really great, great questions. I am going to go for this one that was kind of in the beginning and I will let you guys answer. If you had three or five topmost essential actionable takeaways folks can do to improve their Gut Health on a daily basis. What would that be? I think this is a great way to end this conversation.
Dr. Klaper
(55:28)
Eat whole foods, stop the process, stop all flour products stuff, fruit juices stuff, processed food, stop the processed junk food for starters. Eat enough so-called resistant starches, those are starches that stay intact pretty much all the way through the small intestines down to your colon, those are largely legumes. Make sure that you have got some bean peas, chickpeas, lentils, something that grew in a pod, probably pretty much every day, if not every other day. Stop eating processed foods, eat more legumes, eat more green and yellow vegetables for the insoluble fiber. You absolutely need them. Eat plenty of raw salads, etcetera. One of the benefits is that it is covered with microbes from the garden. It will help freshen up your microbes on fresh raw vegetables as well. Fruits are nicer natural laxatives. They keep things moving. Drink enough water and go out and take a walk every day, keep things moving. Do not sit all day on the computer chairs as I do. You will have a much happier colon, no doubt.
Dr. Miller
(56:38)
I love that. I put a bow on that because that is an awesome answer, do every single one of those things. Then I would add just a couple more. Just really make sure you go for variety. If you have been eating a few certain greens every day, now, it is summer, we can grow, we can get it from farmer's market, CSAs. We have all sorts of options right now. This is a good time to really broaden our microbiome. Really make let this be the summer that you broaden what you are eating, changing it, add different grains if you are in the same thing, really strict it up, change it up. I would say intermittent fasting, really doing a little time restrictive eating, it has made such a difference for my patients. If you are eating late at night or really early in the morning or you are snacking all day long if you really go for your meals and to stop earlier because it makes a huge difference. Then the last thing Dr. Klaper had said earlier but really eat mindfully to remember to slow down and chew. It really helps our cut health too. Even for all these perfect foods, but we eat it fast, and we are stressed out and then we are not going to get the benefits also. In addition to everything that he said, I would say also just slow down and chew it thoroughly, have gratitude for it, appreciate the food, and those would be my tips.
Dr. Klaper
(57:56)
Do not forget the sauerkraut, the fermented food, that help as well.
Dr. Miller
(58:01)
We are going to do a webinar about that one of these days because we want to talk about how people ferment their veggies. I am learning as well this summer. We have some jars going right now. I want to see how they turn out and then we are going to talk about it.
Dr. Marbas
(58:16)
Nothing like personal experimentation.
Dr. Miller
(58:18)
Exactly.
Dr. Miller
(58:19)
Well, thank you all for who have attended via the webinar, or if you are on Facebook, we still appreciate your time. Again, you can make appointments with me Dr. Laurie Marbas, Dr. Chris Miller, Dr. Michael Klaper who needs no introduction and feel free to go to plantbasedtelehealth.com, and we would be happy to help you. We do our webinars live every Thursday at the same time. Noon mountain standard time I am in Colorado. Dr. Klaper and Dr. Miller on the East Coast. That would be 2 p.m. your time and you can find it here. You can register for the webinar or you can join live from the Plant-based Telehealth Facebook Page and we would really appreciate seeing you there. I apologize if we did not get to your question. We had a lot of questions. I had to scroll through and I try to get the ones that were the most folks would be beneficial. Come back next week and maybe we will get your question then. I do appreciate all of you. Any final goodbyes from you guys?
Dr. Miller
(59:16)
Thank you guys for your fun questions and spending an afternoon sometime this afternoon. It is really fun. Nice to see you there. Thank you and stay healthy and stay well.
Dr. Klaper
(59:25)
Amen. You guys are smart, keep eating those plants, and come back next week. We will see you then.
Dr. Marbas
(59:31)
Fantastic, thank you guys again and have a blessed day.
*Recorded on 6.18.20