Sign up for Thorne Emails
Exclusive promotions, personalized product recommendations, wellness content from our experts and more, all delivered to your inbox.
An unhealthy gut lining allows bacteria, toxins, and partially digested food to make its way out of your gut and into your body to wreak havoc, leading to imbalanced levels of inflammation in the gut, a disruption of normal microbiome balance, and can contribute to food sensitivities. In this episode of the Thorne podcast, we breakdown what causes an unhappy gut and what you can do about it.
During this episode you’ll learn about:
Resources to topics mentioned in this episode:
Subscribe to More Content
Make sure to never miss an episode by subscribing to the show on your podcast app. You can also learn more about what we talked about by visiting Thorne.com and checking out the latest news, videos, and stories on Thorne’s Take 5 Daily blog.
During this episode you’ll learn about:
Resources to topics mentioned in this episode:
Subscribe to More Content
Make sure to never miss an episode by subscribing to the show on your podcast app. You can also learn more about what we talked about by visiting Thorne.com and checking out the latest news, videos, and stories on Thorne’s Take 5 Daily blog.
Dr. Robert Rountree:
This is the Thorne Podcast, the show that navigates the complex world of wellness and explores the latest science behind diet, supplements and lifestyle approaches to good health. I'm Dr. Robert Rountree, chief medical advisor at Thorne and functional medicine doctor.
Dr. Frank Lipman:
And I'm Dr. Frank Lipman, New York Times bestseller and functional medicine doctor. As a reminder, the recommendations made in this podcast are the recommendations of the individuals who express them and not the recommendations of Thorne. Statements in this podcast have not been evaluated by the Food and Drug Administration.
Dr. Robert Rountree:
Any products mentioned are not intended to diagnose, treat, cure, or prevent any disease. Hi, everybody. Welcome back to the Thorne Podcast. We're really glad you're here. We're excited to talk about some fascinating topics today. We're talking about the gut this week. Frank, what is your favorite food? What's your all-time favorite meal?
Dr. Frank Lipman:
Well, if I think about my old time favorite meal for the gut, it's probably the no meal, fasting.
Dr. Robert Rountree:
Fasting.
Dr. Frank Lipman:
That would be my all-time favorite meal for the gut. Otherwise I would say I am a huge fan, and maybe because you get attached to things you grow up with. So there's certain types of fish that I grew up with, certain types of steak that I grew up with that we don't get here. So I suppose I still think of them as my favorite meals, but maybe because I can't eat them anymore. I don't eat them anymore.
Dr. Robert Rountree:
Well, let's get into the main topic this week, which is inflammation of the gut. Frank, give me a little perspective on this. I know you treat a lot of people with gut problems. Why do you think gut problems are so common and what does inflammation have to do with it?
Dr. Frank Lipman:
That's a great question. So I think gut problems are so problem because of our lifestyles, because our generation of doctors have given too many drugs to the next generation or to our generation as well. So many of us have been pumped full of antibiotics, proton pump inhibitors, anti-inflammatories and other drugs cause imbalances or affect our gut microbiome. And once you start getting a microbiome that's a little bit off whack, that starts creating all sorts of problems because of the lack of protection of the wall, the production of various metabolites, the lack of production of short-chain fatty acids, which are protective. I think my take on this is a lot of it starts with the microbiome and how our microbiome is affected and then the consequences of a microbiome that's out of whack, which will lead to, whether it's intestinal permeability, inflammation, a lack of short-chain fatty acids, or all the above together.
Dr. Robert Rountree:
So for listeners that for whom that might be a new concept, what would be your definition of the microbiome in a way that, how do you help people understand that if they're not scientists or microbiologists?
Dr. Frank Lipman:
Right. So to me, the microbiome, the way I explain it, the microbiome is this collection of the bacteria in and on us. We have bacteria all over our body, in our armpits, pelvic area, our lungs, our skin, but most of them actually happen to be in our gut. There're more bugs in our gut than cells in our body. So we have this huge organ system in our gut of this collection of bacteria, most of which are playing a very important function in our health. Unfortunately, most of us have this perception of bacteria being bad for us, but actually most of the bacteria in our gut start off being good for us and playing an important function in our body. And once that number decreases or the number of different strains decreases, then we start developing various problems and it can start with inflammation. It can start with maybe irritable bowel syndrome.
Dr. Frank Lipman:
It can start with any, there are many different consequences, but often I feel the underlying issue is this imbalance of the good and the bad bacteria. I hate saying it that way because that's very simplistic, but that is a good way of understanding it. There's not enough good bacteria and overgrowth of bad bacteria or other bugs because it's not only bacteria there. There're fungi. There're viruses. Yeah. So it's this collection of organisms which become imbalanced. That's the beginning of problems. That's the way I explain it, but I'd love to hear how you explain it.
Dr. Robert Rountree:
Well, that's great. I mean, I actually worked my way through college in a microbiology lab. And the concept back then was that there was a handful of potentially harmful bacteria and we were always on the lookout for them. Right? So the work I did in the lab was culturing bacteria. If you had somebody with chronic diarrhea that had just been on a trip, you'd do a stool analysis and you'd look for those bad bacteria, the salmonella, whole concept of Typhoid Mary that people could be carrying these bad bacteria, but that's all we looked for, right? You look for this handful of bacteria and if they weren't there, then you would tell the person, "You're fine." That's expanded a little bit to be able to do a stool analysis based on a sample of what we could grow. So that expand a little bit and we'd say, "Well, you don't have salmonella, but your probiotics are low, your lactobacillus is low. Your bifidobacteria is low and maybe you're growing some yeast."
Dr. Robert Rountree:
And so that was the beginnings of the microbiology studies, but then they found a way to sequence the DNA of all those organisms, including the bacteria, the fungi, the viruses, and that sequencing doesn't require you to be able to take that sample and put it in some kind of test tube and see what you could grow. And all of a sudden it was like this whole world opened up, which was the same thing that happened when, was it Leeuwenhoek that discovered the microscope, put a drop of water under that first homemade microscope and suddenly realized this drop of water is full of all kinds of things that you couldn't see. And that's what we learn about the microbiome is instead of thinking, "Well, either you got bad bugs or you don't, or you've got yeast or you don't," well, there's actually 40 trillion bacteria in there. And half of them we still don't have names for.
Dr. Robert Rountree:
So that's why it's interesting because we've gone from being really specific, "You do or do not have these bad bugs" to, "Oh, we've discovered all these bugs" to what you just said, which is the only thing that's important is the balance of healthy versus unhealthy. So it seems like a crude concept to say, "Well, the balance is what's important," but actually that's where the science is going.
Dr. Frank Lipman:
Right. And diversity is-
Dr. Robert Rountree:
And diversity.
Dr. Frank Lipman:
And many years ago I used to do poop tests and then I stopped because I didn't find them that helpful enough, started doing them a little bit more often. And the common denominator that I do see, because sometimes it can be tricky to read, is if there's poor gut diversity, then it's usually a problem. When people have good gut diversity, that seems to be a protective factor. That's what I'm seeing from this particular poop test. That's one of the few things that seems to be consistent. Good diversity usually means a better gut. Poor diversity usually means more problems.
Dr. Robert Rountree:
And by diversity you mean the variety of things that you see.
Dr. Frank Lipman:
Exactly.
Dr. Robert Rountree:
So in other words, having lots of different bacteria, different types of bacteria is a good thing.
Dr. Frank Lipman:
Exactly. Which makes me think, a lot of the probiotics, no one really knows, but the more I think about this and the more I see patients clinically, in the old days, we used to come up with a probiotic with one or just lactobacillus acidophilus and two, three, maybe four or five strains in higher doses. What I've noticed, and probiotics are tricky and everyone's different, there's no one way, but I'm finding some of these probiotics that have many, many different strains in, and maybe at a lower dose, seem to be, as a general rule, a little bit more effective than these probiotics that have a lot of just a few bacteria. I mean, that's a generalization because that doesn't work for everyone. But that seems to be a pattern that I'm seeing, the more diverse bacteria in a probiotic seem to be better. And in fact, I'm not using probiotics as much as I used to and I'm using more prebiotics and resistant starch. And what's your, I mean, I just find them in a way, a safer bet giving people prebiotics and not as many probiotics. And can you explain why?
Dr. Robert Rountree:
Yeah, well, I do both. I think the prebiotic concept is one that's really taking hold. Prebiotic is basically fertilizer. So if the soil in your garden is sterile, then you can throw lots and lots of seeds in there, which would be the probiotics. And they're not going to do anything if they don't have the right kind of nutrients. So that's how I think about the gut and the prebiotics. The prebiotics are really the nutrients that feed the probiotics. So I always do both. Usually with probiotics, I use a mixture. I'll often do either a formula that's got several strains, at least three strains, or I will have people take, say, bacillus coagulans, which I think has got some pretty good data on it, but I'll also have them take Saccharomyces boulardii. So a lot of times I'm mix and match. Instead of going with like a fixed combination of strains, I'll have people take several different probiotics and I'll have them take a prebiotic formula and something that's getting really popular is potato starch.
Dr. Frank Lipman:
Yeah. I use resistant starch all the time. So that's interesting you say that. For you listeners out there, bacillus coagulans is usually in these spore based probiotics, which is sort of getting the rep that you can use spore based probiotics for SIBO, for instance, and you shouldn't use probiotics for SIBO, which is whatever... For you listeners out there, there're these general probiotic formulas, and then there's bacillus coagulans and the spore based probiotics, which are a little bit different. And then there's Saccharomyces boulardii, which is really like a fungus. So you're talking about three completely different formulas. They're all called probiotics, but they're completely different than, yeah. I actually often use those three together as well.
Dr. Robert Rountree:
And the idea, so we were saying we're going to talk about inflammation. The idea, I think, is that when you've got balance, then you've got good bacteria that help dampen all that inflammation. So I wonder how do you talk to people about the inflammation that's either result of the food they're eating or the imbalance of bacteria or viruses in their gut?
Dr. Frank Lipman:
So I always say to people because one of the commonest questions I'll get asked is what foods are good for inflammation? And my answer's usually it's really what foods are bad for inflammation because it's usually the sugar and starchy foods that are problem. And then I explain to them that everyone understands prebiotics and probiotics, but what we should be really talking about is these postbiotics or these metabolites of the probiotics, which can be anti-inflammatory or pro-inflammatory amongst other things. So you're looking at feeding the right bacteria the right food to make anti-inflammatory probiotics or metabolites. So if you're feeding the wrong bacteria or the wrong food to the bacteria, you're going to get pro-inflammatory metabolites. So my experience has been yes, foods, sugar and starches are probably the worst thing for you and create inflammation, but it's really those bacteria that are the ones creating most of the inflammation. So it's feeding those right, getting the right balance there and correcting that microbiome imbalance, which is key to correcting the inflammation in the gut.
Dr. Robert Rountree:
There's a really interesting study and I think people might know the brand we're talking about, but they gave a meal from this fast food restaurant that I think was like hash browns and sausage and they measured this protein that goes up in the body with inflammation, it's called NF-kappaB. And they found that less than an hour after hating that meal, the NF-kappaB marker of inflammation went sky high and it stayed up for several hours and then it finally started coming back down. And the people that did the study said, "Wait a minute, people usually eat every three or four hours. So if they're eating this typical fast food meal and it's kicking off all this inflammation in the body, then they eat again in three or four hours and the inflammation goes up again. So what happens is they have inflammation all the time." We have this diet that's just producing inflammation.
Dr. Robert Rountree:
People think, "Well, inflammation is what I got when I sprained my ankle or have pneumonia or get a cut and there's inflammation there." But they don't realize that you can have this quiet inflammation that often starts in the gut and spreads throughout the body. And it's just a slow burn that's happening all the time.
Dr. Frank Lipman:
Right. Two points I'd just like to make for our listeners. One is traditional doctors are starting to measure inflammation in the gut now. They measure calprotectin, which is just one inflammatory marker. I mean, I've seen patients who obviously have inflammation in their gut, but their calprotectin level is still normal, which can make sense. And the other thing, and I'd love your take on this, is so many people when they have, let's say, gut inflammation, they'll get a endoscopy or colonoscopy and they have a biopsy and they come back and they say, "Okay, got Crohn's disease or you got ulcerative colitis," which are typical inflammatory bowel diseases. And then once we have that label as a patient in Western medicine, we get given a biologic to treat that inflammation. My experience has been, and I'd love to hear yours, is the inflammation actually being caused by an infection, which goes back to what we were talking about in the beginning.
Dr. Frank Lipman:
And I've seen so many people with ulcerative colitis who've had parasites, so you treat the parasites and the ulcerative colitis, and those changes in the biopsy go away or Crohn's disease that have had a fungus or some microbiome imbalance and you treat that and the Crohn's goes away. So the understanding of inflammation is a sign that obviously something is off, but it's not telling us why you have the inflammation. And it's that classic model of what we like to say in functional medicine, we like to look for the underlying cause. And my experience has been enough of the time the underlying cause is actually a bug or some type of microbiome imbalance which is causing that inflammatory bowel disease. Has that been your experience or not really?
Dr. Robert Rountree:
I think, well, the bigger principle here is that the immune system doesn't just blow up for no reason. Right? So I always think when there's inflammation, there's something that triggered it. And I think bugs are a big trigger. I also think foods can do it. I think certain toxins can do it. Sometimes a person is ingesting a toxic chemical or heavy metal or something. So the list that I always go with is food, bugs, toxins, and trauma. And so trauma could be from taking a ibuprofen, a drug, which traumatizes the lining of the gut.
Dr. Frank Lipman:
Before we take a break, I just saw a patient who was, 9/11 he was in the World Trade Center and he got out and he's obviously swallowed a lot of stuff and it was traumatizing. And after that, he started to have bowel problems. I mean, I just saw him recently, so that's a lot of time after, but he specifically started getting bowel problems after that. And none of the doctors thought it was related, but here we go, trauma and toxins probably because there was a very clear distinction between pre-9/11 for him and post-9/11 for his gut problems. Very interesting.
Dr. Robert Rountree:
And that's trauma on so many different levels. So we need to take a short break now. And when we get back, we'll take some questions from our listeners. Tired of bloating, gas, and other digestive discomfort? Help keep your gut happy and healthy with premium probiotics, digestive enzymes and other innovative solutions by Thorne to support optimal gut health. One example is Thorne's FloraMend Prime Probiotic. This shelf stable and stomach acid resistant probiotic blend offers everyday GI and weight management support take control of the health of your gut. Visit thorne.com to explore probiotics, digestive enzymes and other ways to support happy and healthy gut. That's T-H-O-R-N-E.com. All right, we're back. So now it's time to answer some questions from the community. Our first question this week comes from a listener who asks what bacteria are causing gut inflammation? Is it specific bacteria, Frank?
Dr. Frank Lipman:
No, it's probably, I mean, there may be specific bacteria, but I think it's more about how the bacteria work together and then what metabolites these bacteria make, so what are the postbiotics made by the probiotics, which are causing the inflammation. So, absolutely some, I'm sure there are some specific bacteria that are causing inflammation, but I think it's a much more complicated factory going on in there. It's not just about one bacteria. It's how they work together, what type of metabolites they're making which will then cause the inflammation.
Dr. Robert Rountree:
I would say a kind of a part of the answer. My answer to that is where does this lead? Are you trying to identify a bacteria that you're going to kill with an antibiotic or maybe you're going to regulate the bacteria in the gut? So I'm not saying I'm against using things to knock down bad guys but when I do, I use things that are more gentle, like berberine we've talked about a lot, berberine, garlic, oregano, olive leaf. I do use quote antimicrobials but they're always herbal and they're more gentle. So I don't want to say I never use antibiotics, but I've gotten to where I use them far less frequently.
Dr. Frank Lipman:
Yeah. I feel the same way. I use a lot of herbal antimicrobials with great effect. Okay. So then the next question from a listener is what is an example of an anti-inflammatory diet?
Dr. Robert Rountree:
Well, it sounds like something somebody made up like an alternative medicine term, but it isn't. There's quite a bit of published research on anti-inflammatory diets and probably the best known one is the Mediterranean diet. What's the idea of the Mediterranean diet is kind of a lot of fish and fresh vegetables, no processed foods, minimal amount of red meat, poultry, things like that. So, the first thing is vegetables, lots of fresh vegetables, especially green leafies, and lots of colorful berries, anything that's got red, purple, blue, all of those colors, whether it's from strawberries, raspberries, blueberries, et cetera, they're all very similar in their anti-inflammatory properties. The name of those chemicals are polyphenols and they're well known to be anti-inflammatory. Curcumin. One of the best anti-inflammatory things you can eat. So, curried broccoli, really good anti-inflammatory food. Olive oil, extra virgin olive oil that's really, really green, has a really green kind of tint to it, very anti-inflammatory.
Dr. Frank Lipman:
And I would add taking out the pro-inflammatory foods is even more important, the sugar, the starches, gluten. I find so many people sensitive to gluten and they just take it out, without even knowing they're sensitive, they take gluten out of their diet and they feel better. Dairy sometimes too, but gluten in particular. And I know people think gluten, gluten, and we don't even know, is it the gluten, what the gluten's sprayed with? We don't know why, but I do find it's an easy, quick thing to do. Try taking gluten out of your diet for a week or 10 days and see how you feel. And I'd say most people feel better.
Dr. Robert Rountree:
Certainly for anybody that's got chronic gut inflammation, even if they haven't been diagnosed with Crohn's disease or ulcerative colitis, I think what you're saying is true. I mean, cutting out sugar, dairy, gluten, it just seems like it's really an obvious way to go, an obvious place to start for most people. Frank, does magnesium help with inflammation in your opinion?
Dr. Frank Lipman:
Yeah. I mean, although that's traditionally not an anti-inflammatory per se, I would say it helps with inflammation. I think it helps with a whole host of things from just calming down the nervous system to to muscle cramps to sleep. I mean, I'm a huge fan of magnesium. I've probably, it's one of those key nutrients that I probably recommend to almost everyone because I find so many people deficient and so helpful for so many people. So although it's traditionally not an anti-inflammatory, I would assume it does help with inflammation.
Dr. Robert Rountree:
Yeah. I think there actually are some studies showing that it helps with our natural anti-inflammatory chemicals that we make in the body.
Dr. Frank Lipman:
Interesting. Okay, Bob, next question. Is there such a thing as too much anti-inflammatory consumption?
Dr. Robert Rountree:
I've seen that question come up with regards to fish oil. We know that the omega-3 fatty acids in fish oil actually have anti-inflammatory and even immune suppressant properties. When people have got an autoimmune disease or inflammatory gut disorder will often use a much higher dose than you would normally get from your diet, several grams a day of EPA plus DHA. I've had this discussion with a number of experts, some of whom really believe that you can overdo it with the fish oil, but in my experience, you have to take an awful lot. You'd have to be eating salmon five times a day to really cause that kind of problem. I tend to be on the side of if you're using reasonable amounts, it's hard to cause a problem. Other than fish oil, I don't know of any other food that's going to be quote too strong, that's going to have too potent an anti-inflammatory effect. I mean that the anti-inflammatory effects that you get of foods are nothing like what you get from a drug.
Dr. Frank Lipman:
Right. And when you think of Vascepa, Vascepa, however you pronounce it, the pharmaceutical version of fish oil, is basically, yeah, it's basically a big, strong dose of fish oil.
Dr. Robert Rountree:
And you don't see immunosuppression from that. And the Intuit, the Greenland Inuit, eat huge amounts of EPA and DHA. And you don't see them having an inordinate number of infections or anything like that. So I think when we're talking about foods, it's really hard to overdo it. Certainly with drugs, you can overdo it. So this question keeps coming up, we talked about it. Frank, should I take a probiotic or prebiotic or both for gut inflammation? And if so, what's the best strain?
Dr. Frank Lipman:
Yeah, I would say both. I mean, I always give prebiotics now. More and more I give them in terms, I tell people to eat the stalks and stems. Don't cut them off because that's the fiber that you're not digesting and that feed the good bacteria. I'm using resistant starch, a lot like potato starch, a lot more often now. And I do use probiotics, but yeah, probiotics are trickier. I don't think there's one best strain of probiotic for everyone. What I'm finding is different people seem to respond to different probiotics. Prebiotics are generally good for most people, but it's probably a good idea to take a prebiotic with a probiotic.
Dr. Robert Rountree:
I agree. I think both is always better.
Dr. Frank Lipman:
Okay. So I have a question for you and that is what is the strongest natural anti-inflammatory?
Dr. Robert Rountree:
Natural anti-inflammatory. Well, I would either say it's a toss up between curcumin from turmeric or fish oil. And I usually use both. So those, I mean, if I had to pick my top contenders, it would be those two.
Dr. Frank Lipman:
And I would add quercetin to that.
Dr. Robert Rountree:
Yeah, quercetin as well. Absolutely. And I take all of those, so I hedge my bets.
Dr. Frank Lipman:
Right. Interesting. I'm going for my second vaccine now and I've been loading up on quercetin. I've been telling everyone to load up on some quercetin before and we'll see if it helps.
Dr. Robert Rountree:
I will. I did that and I had zero reaction to my second dose.
Dr. Frank Lipman:
Okay, good.
Dr. Robert Rountree:
So that's an idea I want to plant your head when you get your vaccine is like, I didn't. I kept even thinking, "Okay, it's going to happen. It's going to happen." And I never got a fever, headache, anything like that. I was fine.
Dr. Frank Lipman:
I've heard that same feedback from people I've told to take more quercetin. Hopefully. Yeah.
Dr. Robert Rountree:
So I think we have time for one last question. A reader says this, "I'm bloated after everything, but I've been tested for SIBO, celiac disease, lactose intolerance, H. Pylori. What's going on here and how can I support my gut?" And I got to say this-
Dr. Frank Lipman:
That's common.
Dr. Robert Rountree:
This is a familiar scenario. [crosstalk 00:27:21]
Dr. Frank Lipman:
Yeah. So people need to understand that the SIBO test is testing for very specific bugs and the gasses they release. So just because you're negative for SIBO does not mean you're negative for general dysbiosis or imbalance, so you're negative or those specific organisms that are causing that particular gas. So to me, when someone is bloated, they're either eating a food that they're not digesting properly. They don't have enough, especially if they're older, hydrochloric acid or maybe digestive enzymes and then once again, there's this imbalance in the gut where I use anti-microbials. So I do for something like this, which is very, very common, I will put people on some type of elimination diet where I'll take sugar and gluten and dairy out of their diets. Depending on their agent's symptoms. I'll sometimes tell them to have some bitters before they eat, and then I'll use anti-microbials like berberine, olive leaf extract, oregano oil.
Dr. Frank Lipman:
So that's a very common problem in it. Once again, it's what is causing that. It's usually because of food that you're not digesting properly, or you're not making enough digestive juices, or you've got this imbalance in the good and the bad bacteria. So you need to just try and work out what it is. And it's actually usually quite easy and quite easy to treat, too.
Dr. Robert Rountree:
Sure. Yep. I agree. I think sometimes the standard tests just aren't good enough and it's always worth trying things. I think in mainstream medicine that the lack of digestive enzymes, what we call brush border enzymes, and the lack of hydrochloric acid, it's under appreciated. And I also think people need to understand that when they take a supplement of a digestive enzyme, you really have to work hard to overdo it. I mean the typical dose that's on the label is one to two caps, but I'll often have people take four to six.
Dr. Frank Lipman:
Me, too. Exactly.
Dr. Robert Rountree:
So you can really push the dose. All right, folks, that's all the time we have this week. Thank you so much for listening and tuning in. Thank you, Frank, for podcasting. It's always a pleasure.
Dr. Frank Lipman:
Absolute pleasure. Thanks for listening to the Thorne Podcast. Make sure to never miss an episode by subscribing to the show on your podcast app of choice.
Dr. Robert Rountree:
If you've got a health or wellness question you'd like answered, simply follow our Instagram and shoot a message to @thorneresearch. You can also learn more about the topics we discussed by visiting thorne.com and checking out the latest news, videos and stories on Thorne's Take 5 daily blog.
Dr. Frank Lipman:
Once again, thanks for tuning in and don't forget to join us next time for another episode of the Thorne podcast.
Dr. Robert Rountree:
This is the Thorne Podcast, the show that navigates the complex world of wellness and explores the latest science behind diet, supplements and lifestyle approaches to good health. I'm Dr. Robert Rountree, chief medical advisor at Thorne and functional medicine doctor.
Dr. Frank Lipman:
And I'm Dr. Frank Lipman, New York Times bestseller and functional medicine doctor. As a reminder, the recommendations made in this podcast are the recommendations of the individuals who express them and not the recommendations of Thorne. Statements in this podcast have not been evaluated by the Food and Drug Administration.
Dr. Robert Rountree:
Any products mentioned are not intended to diagnose, treat, cure, or prevent any disease. Hi, everybody. Welcome back to the Thorne Podcast. We're really glad you're here. We're excited to talk about some fascinating topics today. We're talking about the gut this week. Frank, what is your favorite food? What's your all-time favorite meal?
Dr. Frank Lipman:
Well, if I think about my old time favorite meal for the gut, it's probably the no meal, fasting.
Dr. Robert Rountree:
Fasting.
Dr. Frank Lipman:
That would be my all-time favorite meal for the gut. Otherwise I would say I am a huge fan, and maybe because you get attached to things you grow up with. So there's certain types of fish that I grew up with, certain types of steak that I grew up with that we don't get here. So I suppose I still think of them as my favorite meals, but maybe because I can't eat them anymore. I don't eat them anymore.
Dr. Robert Rountree:
Well, let's get into the main topic this week, which is inflammation of the gut. Frank, give me a little perspective on this. I know you treat a lot of people with gut problems. Why do you think gut problems are so common and what does inflammation have to do with it?
Dr. Frank Lipman:
That's a great question. So I think gut problems are so problem because of our lifestyles, because our generation of doctors have given too many drugs to the next generation or to our generation as well. So many of us have been pumped full of antibiotics, proton pump inhibitors, anti-inflammatories and other drugs cause imbalances or affect our gut microbiome. And once you start getting a microbiome that's a little bit off whack, that starts creating all sorts of problems because of the lack of protection of the wall, the production of various metabolites, the lack of production of short-chain fatty acids, which are protective. I think my take on this is a lot of it starts with the microbiome and how our microbiome is affected and then the consequences of a microbiome that's out of whack, which will lead to, whether it's intestinal permeability, inflammation, a lack of short-chain fatty acids, or all the above together.
Dr. Robert Rountree:
So for listeners that for whom that might be a new concept, what would be your definition of the microbiome in a way that, how do you help people understand that if they're not scientists or microbiologists?
Dr. Frank Lipman:
Right. So to me, the microbiome, the way I explain it, the microbiome is this collection of the bacteria in and on us. We have bacteria all over our body, in our armpits, pelvic area, our lungs, our skin, but most of them actually happen to be in our gut. There're more bugs in our gut than cells in our body. So we have this huge organ system in our gut of this collection of bacteria, most of which are playing a very important function in our health. Unfortunately, most of us have this perception of bacteria being bad for us, but actually most of the bacteria in our gut start off being good for us and playing an important function in our body. And once that number decreases or the number of different strains decreases, then we start developing various problems and it can start with inflammation. It can start with maybe irritable bowel syndrome.
Dr. Frank Lipman:
It can start with any, there are many different consequences, but often I feel the underlying issue is this imbalance of the good and the bad bacteria. I hate saying it that way because that's very simplistic, but that is a good way of understanding it. There's not enough good bacteria and overgrowth of bad bacteria or other bugs because it's not only bacteria there. There're fungi. There're viruses. Yeah. So it's this collection of organisms which become imbalanced. That's the beginning of problems. That's the way I explain it, but I'd love to hear how you explain it.
Dr. Robert Rountree:
Well, that's great. I mean, I actually worked my way through college in a microbiology lab. And the concept back then was that there was a handful of potentially harmful bacteria and we were always on the lookout for them. Right? So the work I did in the lab was culturing bacteria. If you had somebody with chronic diarrhea that had just been on a trip, you'd do a stool analysis and you'd look for those bad bacteria, the salmonella, whole concept of Typhoid Mary that people could be carrying these bad bacteria, but that's all we looked for, right? You look for this handful of bacteria and if they weren't there, then you would tell the person, "You're fine." That's expanded a little bit to be able to do a stool analysis based on a sample of what we could grow. So that expand a little bit and we'd say, "Well, you don't have salmonella, but your probiotics are low, your lactobacillus is low. Your bifidobacteria is low and maybe you're growing some yeast."
Dr. Robert Rountree:
And so that was the beginnings of the microbiology studies, but then they found a way to sequence the DNA of all those organisms, including the bacteria, the fungi, the viruses, and that sequencing doesn't require you to be able to take that sample and put it in some kind of test tube and see what you could grow. And all of a sudden it was like this whole world opened up, which was the same thing that happened when, was it Leeuwenhoek that discovered the microscope, put a drop of water under that first homemade microscope and suddenly realized this drop of water is full of all kinds of things that you couldn't see. And that's what we learn about the microbiome is instead of thinking, "Well, either you got bad bugs or you don't, or you've got yeast or you don't," well, there's actually 40 trillion bacteria in there. And half of them we still don't have names for.
Dr. Robert Rountree:
So that's why it's interesting because we've gone from being really specific, "You do or do not have these bad bugs" to, "Oh, we've discovered all these bugs" to what you just said, which is the only thing that's important is the balance of healthy versus unhealthy. So it seems like a crude concept to say, "Well, the balance is what's important," but actually that's where the science is going.
Dr. Frank Lipman:
Right. And diversity is-
Dr. Robert Rountree:
And diversity.
Dr. Frank Lipman:
And many years ago I used to do poop tests and then I stopped because I didn't find them that helpful enough, started doing them a little bit more often. And the common denominator that I do see, because sometimes it can be tricky to read, is if there's poor gut diversity, then it's usually a problem. When people have good gut diversity, that seems to be a protective factor. That's what I'm seeing from this particular poop test. That's one of the few things that seems to be consistent. Good diversity usually means a better gut. Poor diversity usually means more problems.
Dr. Robert Rountree:
And by diversity you mean the variety of things that you see.
Dr. Frank Lipman:
Exactly.
Dr. Robert Rountree:
So in other words, having lots of different bacteria, different types of bacteria is a good thing.
Dr. Frank Lipman:
Exactly. Which makes me think, a lot of the probiotics, no one really knows, but the more I think about this and the more I see patients clinically, in the old days, we used to come up with a probiotic with one or just lactobacillus acidophilus and two, three, maybe four or five strains in higher doses. What I've noticed, and probiotics are tricky and everyone's different, there's no one way, but I'm finding some of these probiotics that have many, many different strains in, and maybe at a lower dose, seem to be, as a general rule, a little bit more effective than these probiotics that have a lot of just a few bacteria. I mean, that's a generalization because that doesn't work for everyone. But that seems to be a pattern that I'm seeing, the more diverse bacteria in a probiotic seem to be better. And in fact, I'm not using probiotics as much as I used to and I'm using more prebiotics and resistant starch. And what's your, I mean, I just find them in a way, a safer bet giving people prebiotics and not as many probiotics. And can you explain why?
Dr. Robert Rountree:
Yeah, well, I do both. I think the prebiotic concept is one that's really taking hold. Prebiotic is basically fertilizer. So if the soil in your garden is sterile, then you can throw lots and lots of seeds in there, which would be the probiotics. And they're not going to do anything if they don't have the right kind of nutrients. So that's how I think about the gut and the prebiotics. The prebiotics are really the nutrients that feed the probiotics. So I always do both. Usually with probiotics, I use a mixture. I'll often do either a formula that's got several strains, at least three strains, or I will have people take, say, bacillus coagulans, which I think has got some pretty good data on it, but I'll also have them take Saccharomyces boulardii. So a lot of times I'm mix and match. Instead of going with like a fixed combination of strains, I'll have people take several different probiotics and I'll have them take a prebiotic formula and something that's getting really popular is potato starch.
Dr. Frank Lipman:
Yeah. I use resistant starch all the time. So that's interesting you say that. For you listeners out there, bacillus coagulans is usually in these spore based probiotics, which is sort of getting the rep that you can use spore based probiotics for SIBO, for instance, and you shouldn't use probiotics for SIBO, which is whatever... For you listeners out there, there're these general probiotic formulas, and then there's bacillus coagulans and the spore based probiotics, which are a little bit different. And then there's Saccharomyces boulardii, which is really like a fungus. So you're talking about three completely different formulas. They're all called probiotics, but they're completely different than, yeah. I actually often use those three together as well.
Dr. Robert Rountree:
And the idea, so we were saying we're going to talk about inflammation. The idea, I think, is that when you've got balance, then you've got good bacteria that help dampen all that inflammation. So I wonder how do you talk to people about the inflammation that's either result of the food they're eating or the imbalance of bacteria or viruses in their gut?
Dr. Frank Lipman:
So I always say to people because one of the commonest questions I'll get asked is what foods are good for inflammation? And my answer's usually it's really what foods are bad for inflammation because it's usually the sugar and starchy foods that are problem. And then I explain to them that everyone understands prebiotics and probiotics, but what we should be really talking about is these postbiotics or these metabolites of the probiotics, which can be anti-inflammatory or pro-inflammatory amongst other things. So you're looking at feeding the right bacteria the right food to make anti-inflammatory probiotics or metabolites. So if you're feeding the wrong bacteria or the wrong food to the bacteria, you're going to get pro-inflammatory metabolites. So my experience has been yes, foods, sugar and starches are probably the worst thing for you and create inflammation, but it's really those bacteria that are the ones creating most of the inflammation. So it's feeding those right, getting the right balance there and correcting that microbiome imbalance, which is key to correcting the inflammation in the gut.
Dr. Robert Rountree:
There's a really interesting study and I think people might know the brand we're talking about, but they gave a meal from this fast food restaurant that I think was like hash browns and sausage and they measured this protein that goes up in the body with inflammation, it's called NF-kappaB. And they found that less than an hour after hating that meal, the NF-kappaB marker of inflammation went sky high and it stayed up for several hours and then it finally started coming back down. And the people that did the study said, "Wait a minute, people usually eat every three or four hours. So if they're eating this typical fast food meal and it's kicking off all this inflammation in the body, then they eat again in three or four hours and the inflammation goes up again. So what happens is they have inflammation all the time." We have this diet that's just producing inflammation.
Dr. Robert Rountree:
People think, "Well, inflammation is what I got when I sprained my ankle or have pneumonia or get a cut and there's inflammation there." But they don't realize that you can have this quiet inflammation that often starts in the gut and spreads throughout the body. And it's just a slow burn that's happening all the time.
Dr. Frank Lipman:
Right. Two points I'd just like to make for our listeners. One is traditional doctors are starting to measure inflammation in the gut now. They measure calprotectin, which is just one inflammatory marker. I mean, I've seen patients who obviously have inflammation in their gut, but their calprotectin level is still normal, which can make sense. And the other thing, and I'd love your take on this, is so many people when they have, let's say, gut inflammation, they'll get a endoscopy or colonoscopy and they have a biopsy and they come back and they say, "Okay, got Crohn's disease or you got ulcerative colitis," which are typical inflammatory bowel diseases. And then once we have that label as a patient in Western medicine, we get given a biologic to treat that inflammation. My experience has been, and I'd love to hear yours, is the inflammation actually being caused by an infection, which goes back to what we were talking about in the beginning.
Dr. Frank Lipman:
And I've seen so many people with ulcerative colitis who've had parasites, so you treat the parasites and the ulcerative colitis, and those changes in the biopsy go away or Crohn's disease that have had a fungus or some microbiome imbalance and you treat that and the Crohn's goes away. So the understanding of inflammation is a sign that obviously something is off, but it's not telling us why you have the inflammation. And it's that classic model of what we like to say in functional medicine, we like to look for the underlying cause. And my experience has been enough of the time the underlying cause is actually a bug or some type of microbiome imbalance which is causing that inflammatory bowel disease. Has that been your experience or not really?
Dr. Robert Rountree:
I think, well, the bigger principle here is that the immune system doesn't just blow up for no reason. Right? So I always think when there's inflammation, there's something that triggered it. And I think bugs are a big trigger. I also think foods can do it. I think certain toxins can do it. Sometimes a person is ingesting a toxic chemical or heavy metal or something. So the list that I always go with is food, bugs, toxins, and trauma. And so trauma could be from taking a ibuprofen, a drug, which traumatizes the lining of the gut.
Dr. Frank Lipman:
Before we take a break, I just saw a patient who was, 9/11 he was in the World Trade Center and he got out and he's obviously swallowed a lot of stuff and it was traumatizing. And after that, he started to have bowel problems. I mean, I just saw him recently, so that's a lot of time after, but he specifically started getting bowel problems after that. And none of the doctors thought it was related, but here we go, trauma and toxins probably because there was a very clear distinction between pre-9/11 for him and post-9/11 for his gut problems. Very interesting.
Dr. Robert Rountree:
And that's trauma on so many different levels. So we need to take a short break now. And when we get back, we'll take some questions from our listeners. Tired of bloating, gas, and other digestive discomfort? Help keep your gut happy and healthy with premium probiotics, digestive enzymes and other innovative solutions by Thorne to support optimal gut health. One example is Thorne's FloraMend Prime Probiotic. This shelf stable and stomach acid resistant probiotic blend offers everyday GI and weight management support take control of the health of your gut. Visit thorne.com to explore probiotics, digestive enzymes and other ways to support happy and healthy gut. That's T-H-O-R-N-E.com. All right, we're back. So now it's time to answer some questions from the community. Our first question this week comes from a listener who asks what bacteria are causing gut inflammation? Is it specific bacteria, Frank?
Dr. Frank Lipman:
No, it's probably, I mean, there may be specific bacteria, but I think it's more about how the bacteria work together and then what metabolites these bacteria make, so what are the postbiotics made by the probiotics, which are causing the inflammation. So, absolutely some, I'm sure there are some specific bacteria that are causing inflammation, but I think it's a much more complicated factory going on in there. It's not just about one bacteria. It's how they work together, what type of metabolites they're making which will then cause the inflammation.
Dr. Robert Rountree:
I would say a kind of a part of the answer. My answer to that is where does this lead? Are you trying to identify a bacteria that you're going to kill with an antibiotic or maybe you're going to regulate the bacteria in the gut? So I'm not saying I'm against using things to knock down bad guys but when I do, I use things that are more gentle, like berberine we've talked about a lot, berberine, garlic, oregano, olive leaf. I do use quote antimicrobials but they're always herbal and they're more gentle. So I don't want to say I never use antibiotics, but I've gotten to where I use them far less frequently.
Dr. Frank Lipman:
Yeah. I feel the same way. I use a lot of herbal antimicrobials with great effect. Okay. So then the next question from a listener is what is an example of an anti-inflammatory diet?
Dr. Robert Rountree:
Well, it sounds like something somebody made up like an alternative medicine term, but it isn't. There's quite a bit of published research on anti-inflammatory diets and probably the best known one is the Mediterranean diet. What's the idea of the Mediterranean diet is kind of a lot of fish and fresh vegetables, no processed foods, minimal amount of red meat, poultry, things like that. So, the first thing is vegetables, lots of fresh vegetables, especially green leafies, and lots of colorful berries, anything that's got red, purple, blue, all of those colors, whether it's from strawberries, raspberries, blueberries, et cetera, they're all very similar in their anti-inflammatory properties. The name of those chemicals are polyphenols and they're well known to be anti-inflammatory. Curcumin. One of the best anti-inflammatory things you can eat. So, curried broccoli, really good anti-inflammatory food. Olive oil, extra virgin olive oil that's really, really green, has a really green kind of tint to it, very anti-inflammatory.
Dr. Frank Lipman:
And I would add taking out the pro-inflammatory foods is even more important, the sugar, the starches, gluten. I find so many people sensitive to gluten and they just take it out, without even knowing they're sensitive, they take gluten out of their diet and they feel better. Dairy sometimes too, but gluten in particular. And I know people think gluten, gluten, and we don't even know, is it the gluten, what the gluten's sprayed with? We don't know why, but I do find it's an easy, quick thing to do. Try taking gluten out of your diet for a week or 10 days and see how you feel. And I'd say most people feel better.
Dr. Robert Rountree:
Certainly for anybody that's got chronic gut inflammation, even if they haven't been diagnosed with Crohn's disease or ulcerative colitis, I think what you're saying is true. I mean, cutting out sugar, dairy, gluten, it just seems like it's really an obvious way to go, an obvious place to start for most people. Frank, does magnesium help with inflammation in your opinion?
Dr. Frank Lipman:
Yeah. I mean, although that's traditionally not an anti-inflammatory per se, I would say it helps with inflammation. I think it helps with a whole host of things from just calming down the nervous system to to muscle cramps to sleep. I mean, I'm a huge fan of magnesium. I've probably, it's one of those key nutrients that I probably recommend to almost everyone because I find so many people deficient and so helpful for so many people. So although it's traditionally not an anti-inflammatory, I would assume it does help with inflammation.
Dr. Robert Rountree:
Yeah. I think there actually are some studies showing that it helps with our natural anti-inflammatory chemicals that we make in the body.
Dr. Frank Lipman:
Interesting. Okay, Bob, next question. Is there such a thing as too much anti-inflammatory consumption?
Dr. Robert Rountree:
I've seen that question come up with regards to fish oil. We know that the omega-3 fatty acids in fish oil actually have anti-inflammatory and even immune suppressant properties. When people have got an autoimmune disease or inflammatory gut disorder will often use a much higher dose than you would normally get from your diet, several grams a day of EPA plus DHA. I've had this discussion with a number of experts, some of whom really believe that you can overdo it with the fish oil, but in my experience, you have to take an awful lot. You'd have to be eating salmon five times a day to really cause that kind of problem. I tend to be on the side of if you're using reasonable amounts, it's hard to cause a problem. Other than fish oil, I don't know of any other food that's going to be quote too strong, that's going to have too potent an anti-inflammatory effect. I mean that the anti-inflammatory effects that you get of foods are nothing like what you get from a drug.
Dr. Frank Lipman:
Right. And when you think of Vascepa, Vascepa, however you pronounce it, the pharmaceutical version of fish oil, is basically, yeah, it's basically a big, strong dose of fish oil.
Dr. Robert Rountree:
And you don't see immunosuppression from that. And the Intuit, the Greenland Inuit, eat huge amounts of EPA and DHA. And you don't see them having an inordinate number of infections or anything like that. So I think when we're talking about foods, it's really hard to overdo it. Certainly with drugs, you can overdo it. So this question keeps coming up, we talked about it. Frank, should I take a probiotic or prebiotic or both for gut inflammation? And if so, what's the best strain?
Dr. Frank Lipman:
Yeah, I would say both. I mean, I always give prebiotics now. More and more I give them in terms, I tell people to eat the stalks and stems. Don't cut them off because that's the fiber that you're not digesting and that feed the good bacteria. I'm using resistant starch, a lot like potato starch, a lot more often now. And I do use probiotics, but yeah, probiotics are trickier. I don't think there's one best strain of probiotic for everyone. What I'm finding is different people seem to respond to different probiotics. Prebiotics are generally good for most people, but it's probably a good idea to take a prebiotic with a probiotic.
Dr. Robert Rountree:
I agree. I think both is always better.
Dr. Frank Lipman:
Okay. So I have a question for you and that is what is the strongest natural anti-inflammatory?
Dr. Robert Rountree:
Natural anti-inflammatory. Well, I would either say it's a toss up between curcumin from turmeric or fish oil. And I usually use both. So those, I mean, if I had to pick my top contenders, it would be those two.
Dr. Frank Lipman:
And I would add quercetin to that.
Dr. Robert Rountree:
Yeah, quercetin as well. Absolutely. And I take all of those, so I hedge my bets.
Dr. Frank Lipman:
Right. Interesting. I'm going for my second vaccine now and I've been loading up on quercetin. I've been telling everyone to load up on some quercetin before and we'll see if it helps.
Dr. Robert Rountree:
I will. I did that and I had zero reaction to my second dose.
Dr. Frank Lipman:
Okay, good.
Dr. Robert Rountree:
So that's an idea I want to plant your head when you get your vaccine is like, I didn't. I kept even thinking, "Okay, it's going to happen. It's going to happen." And I never got a fever, headache, anything like that. I was fine.
Dr. Frank Lipman:
I've heard that same feedback from people I've told to take more quercetin. Hopefully. Yeah.
Dr. Robert Rountree:
So I think we have time for one last question. A reader says this, "I'm bloated after everything, but I've been tested for SIBO, celiac disease, lactose intolerance, H. Pylori. What's going on here and how can I support my gut?" And I got to say this-
Dr. Frank Lipman:
That's common.
Dr. Robert Rountree:
This is a familiar scenario. [crosstalk 00:27:21]
Dr. Frank Lipman:
Yeah. So people need to understand that the SIBO test is testing for very specific bugs and the gasses they release. So just because you're negative for SIBO does not mean you're negative for general dysbiosis or imbalance, so you're negative or those specific organisms that are causing that particular gas. So to me, when someone is bloated, they're either eating a food that they're not digesting properly. They don't have enough, especially if they're older, hydrochloric acid or maybe digestive enzymes and then once again, there's this imbalance in the gut where I use anti-microbials. So I do for something like this, which is very, very common, I will put people on some type of elimination diet where I'll take sugar and gluten and dairy out of their diets. Depending on their agent's symptoms. I'll sometimes tell them to have some bitters before they eat, and then I'll use anti-microbials like berberine, olive leaf extract, oregano oil.
Dr. Frank Lipman:
So that's a very common problem in it. Once again, it's what is causing that. It's usually because of food that you're not digesting properly, or you're not making enough digestive juices, or you've got this imbalance in the good and the bad bacteria. So you need to just try and work out what it is. And it's actually usually quite easy and quite easy to treat, too.
Dr. Robert Rountree:
Sure. Yep. I agree. I think sometimes the standard tests just aren't good enough and it's always worth trying things. I think in mainstream medicine that the lack of digestive enzymes, what we call brush border enzymes, and the lack of hydrochloric acid, it's under appreciated. And I also think people need to understand that when they take a supplement of a digestive enzyme, you really have to work hard to overdo it. I mean the typical dose that's on the label is one to two caps, but I'll often have people take four to six.
Dr. Frank Lipman:
Me, too. Exactly.
Dr. Robert Rountree:
So you can really push the dose. All right, folks, that's all the time we have this week. Thank you so much for listening and tuning in. Thank you, Frank, for podcasting. It's always a pleasure.
Dr. Frank Lipman:
Absolute pleasure. Thanks for listening to the Thorne Podcast. Make sure to never miss an episode by subscribing to the show on your podcast app of choice.
Dr. Robert Rountree:
If you've got a health or wellness question you'd like answered, simply follow our Instagram and shoot a message to @thorneresearch. You can also learn more about the topics we discussed by visiting thorne.com and checking out the latest news, videos and stories on Thorne's Take 5 daily blog.
Dr. Frank Lipman:
Once again, thanks for tuning in and don't forget to join us next time for another episode of the Thorne podcast.
Note: This episode originally aired in July 2022. In part one of this two-part series, Dr. Robert Rountree and Dr. Frank Lipman dive deep into the topic of anxiety. Learn about the different types ...
April 9, 2024 • Thorne
In part two of this two-part series, Dr. Rountree and Dr. Lipman take a closer look at the topic of depression. Learn about the gut-brain connection and its link with depression, cytokine sickness,...
July 23, 2022 • Thorne
You took Thorne's Gut Health Test, but what do your results really mean for your health? Vice President of Medical Affairs Amanda Frick joins Chief Medical Advisor Robert Rountree as they analyze a...
April 22, 2023 • Thorne
