Tips for a Healthy Gut with Dr. Robynne Chutkan

Published Aug 21, 2024, 7:01 AM

Should I be taking probiotics,  prebiotics or postbiotics? What is a microbiome? Gut Health is in the zeitgeist and there are very few people who can explain it like Dr. Robynne Chutkan – a renowned gastroenterologist, author of several bestselling digestive health books, and host of The Gutbliss Podcast. On this week’s Wellness Wednesday, Dr. Chutkan gives us tips for the lifestyle changes we can make today for our healthiest microbiome and our gut health. 

Hey, besties, Hello Sunshine.

Today on the bright Side, it's Wellness Wednesday, So we're delving into a fascinating topic, your gut. Did you know your gut might just be your second brain. We're exploring the ins and outs of gut health and the incredible connection between our stomachs and our minds. So joining us is doctor Robin Shutkin, a renowned gastro entrologist and author of several best selling digestive health books.

She'll guide us through everything.

We need to know about nourishing our guts and feeling our best. Plus, we'll tackle the big question how safe are antibiotics. It's Wednesday, August twenty First, I'm Danielle Robe.

And I'm Simone Boyce. And this is the bright Side from Hello Sunshine, a daily show where we come together to share women's stories, laugh, learn and brighten your day.

Today's Wellness Wednesday is presented by Coligard.

Okay, Danielle, tell me if you relate to this. I find it hard to leave the grocery store these days without purchasing at least one gut health product. Oh yeah, I'm a kumbucha girl. Out the way, there are probiotic Seltzers. There's kombucha, probiotic shots, countless supplements. I mean, the list goes on. It's honestly overwhelming, and I, for one don't necessarily know what's actually effective and what's just effective marketing.

Do you use any of those gut health products personally?

I do. I take seed supplements inconsistently, but whenever I am consistent with it, I've noticed a difference.

Yeah, I also will.

I'll throw back like a Biokay probiotics shot that basically tastes like spoiled yogurt. I do eat a lot of yogurt, which I think is really good for your gut.

How about you.

I take Lovebug probiotics. I actually get a lot of sinus infections. I feel like everybody gets like one illness that pops up over and over again.

Some people get stripped throat.

I'm a sinus infection girl, and so I've always taken antibiotics to get rid of them, which is so bad for your gut health. And so after the antibiotics, I take probiotics, and so I just started taking them every day. And I have to tell you I've been influenced by Gwyneth Paltrow because I looked up which one she recommends, and she takes these Lovebug probiotics and you feel like it works. Yeah, they really helped my gut health. I actually felt bloating after I took antibiotics for a little bit, and this really helped.

I think that's an area that I'm unclear on, is how do we know our gut is healthy or not? You know, like, what are the signs that we need to be paying attention to.

I think that's a great question, and it's something that we're going to get into today because we're talking about gut health and we want to look at the science and dispel these myths. So Doctor Robin Shutkin is a gastro entrologist and author of several digestive health books, including Gut Bliss, The Microbiome Solution, and The Blokecure. She's also the founder of the Digestive Center for Wellness, a gastroentrology practice is dedicated to uncovering the root cause of GI disorders, and she's the host of the Gut Bliss podcast. She's really talking about our guts.

Oh, she knows her stuff, So let's bring her in. Welcome to the bright Side, Doctor chuck.

In, Thank you so much, it's so great to be with you.

Well, we're so excited to talk to you today because gut health is in the zeitgeist, and I think there are very few people that can really break it down and explain what gut health means. Now, I want to start with something that I've heard around town. I've heard that we have three brains. We have the one in our head, one in our heart, and there's actually a third brain in our gut.

Yes, absolutely, the second brain. You're talking about the enteric nervous system. And fun fact, we have about seven times as many nerve cells in our gut as we have in our spinal cord. Now, we don't have as many as we have in our central nervous system. But the second brain is a real thing. And think about when you get butterflies in your stomach, or you have that gut fing to not do that thing, but you do it anyway.

And then you regret it.

Those are actually real feelings based on neurotransmitters and nerve cells and actual neurological processes that are going on in our gut.

Wait, so what do those butterflies mean?

Then?

So I want you just for a minute to think about where the gut is located. It is in the exact center of our body. It's literally the engine, and so it connects to the brain, It connects to the lungs, the heart, the immune system, the kidneys, all of these different organs, and it literally feeds them. When it comes to the brain, it's this bidirectional communication through a nerve called the vagus nerve, and also through the fact that many, many, many of the neurotransmitters like serotonin and dopamine, et cetera that work in our brain are actually made in our gut. And so, for example, our gut influences things like mood and cognition and memory, and our brain influences things like motility, how well our gut moves, enzyme secretion, digestion. So one of the things that it's so important for people to realize is that these things that we think are just in our head are really in our body. And that's why it's so important to consider these reactions and these factors when we think about gut health. Gut health isn't just what we eat and drink and exercising. It's also what we think, and it's also how we handle stress. And there are all these studies now that show that cognitive behavioral therapy, whether that takes a form of guided imagery, deep breathing, whatever it is, can be not just as effective as medication, but more effective than medication for conditions like irritable bowel syndrome, et cetera. And so this is such powerful stuff because unlike some of these medications, which may be magnificent, but they all have side effects. So you know, deep breathing, guided imagery, that's not going to do anything bad for you. All that's going to do is trigger your parasympathetic system, your rest and digest, and make you healthier. I love that we have these things in our toolbox. And it's really not either or if you're on prescription medication and that's really helping good for you, but it's good to know that there are additional things, and some of these things are actually more effective than the prescription drugs.

I hear the word microbiome a lot when we talk about gut health, and I don't actually quite know what it means.

What is our microbiome?

The microbiome refers to all the microscopic organisms that live in and on our body, and so often we think bacteria, but it's not just bacteria. It's viruses, it's parasitic organisms, it's helmets otherwise known as worms.

It is wan.

Cell protozoa organisms, it's archaos.

It's a wide range of microscopic critters, if you will, that live in our body, mostly in our gi tract. And these microbs are microscopic, but if we scrape them all up, they would weigh about four pounds. So we're talking about a lot of organisms. And they're also on our body. They're on our skin, they're in our ears or in our mouth, they're in our vaginas or up our noses. They are literally everywhere. We even have microbes in organs that we thought were previously sterile, like our lungs. It turns out, oh no, we have bacteria in our lungs. It's just that when we have the wrong head of bacteria in there, we run into problems. So they literally took us about four hundred years to figure out that most of these microbes are our friends, not our enemies, and that their health is very closely intertwined with our health, and that they have our back basically because you know what if we die, so do they wear the host. So they want to keep the host alive and healthy so that they can thrive, and so Over the last I would say two or three decades, there has been an explosion of data literature about the microbiome, and study after study after study showing that actually, you know, killing off all these microbes and scrubbing ourselves clean and using antibiotics and all these different things that damage or microbiome, all those practices are actually making us sicker, not healthier. Even in the time I went to medical school in the nineties and we were singularly focused on being as clean as possible, and the same for our patients. And there are definitely times when being clean is really important. You know, if you're in an operating room, you want that environment to be sterile. But in terms of just general self care, the shift has really moved away from this sort of super sanitization and being super clean into realizing, like, no kids need to be outside getting dirty and exposure to soil, microbes in nature, all these things are really important for maintaining health.

We have to take a quick break, but we'll be right back with more from doctor Robin Chuckkin.

Stay with us.

We're back with doctor Robin Chuckin. I read that we're actually exposed to bacteria from the moment we're born, and that a lot of babies get their first dose of it from the birth canal. Is that where the microbiome comes from.

That's such a great question, and you are absolutely right, And it turns out the fetus itself in the womb is not even sterile. It's even exposed to some microbes early on, but not a lot and very select ones. And that passage through the birth canal, a vaginal birth is literally the most important moment in your life because that is when you become colonized with the founding species, with your man, your mother's microbiome, the Lactobacillus, bithidobacteria, et cetera. That are going to set you up for success. And what we see is that babies who are born via sea section have higher rates of four really serious things autoimmune disease, asthma, allergies, and obesity, and those things can follow them into young adulthood.

Well, doctor Shakin, you've been pretty open about your own experience with this. Your daughter was born VC section, right.

Yes, it completely changed my trajectory from being a conventional guest room trologist who was doing lots of colonosko be writing lots of prescriptions to really understanding the impact of the microbiome. So I was thirty nine when I had my daughter, So I was what they call advanced maternal age. But I was super healthy, no medical problems. I was, you know, running, swimming, doing all these things. So I was in really good health. And when my water broke, I remember like going to the hospital. I got there around nine am and I was like, Okay, by four pm, I'm going to have me a baby. I was convinced that my baby was going to be born during the Oprah Show between like four and five PM. And I can't remember what episode it was. I keep meaning to look back and see what Oprah came and went, no baby. And one of the things I got they asked me, you know, they're like, would you like an epidural? And you're like, really, I am in like agony hair, and you're saying you can relieve some of that pain. Oh yes, please, So you get an epidural, But they don't tell you that getting an epidural is going to significantly increase your risk of a sea section. And of course for me, even as a physician, I didn't know about sea sections being associated with all these significant conditions in the baby. So I'm like, oh, yes, please please stick that needle in my back and take away my pain. So you get an epidural, and then my labor is a little bit of failure to progress, and so they're like, oh, well, we're going to give you something to speed up labor, something to induce labor, and I was like, oh, that sounds great. They don't tell you that that medication they're giving you to induce labor also is going to cause a higher likelihood of sea section. And again not second guessing these decisions. I think these are all very reasonable medical decisions, but just pointing out that how someone like me as a physician, was really unaware this stuff, and had I known, I probably would have said, you know, I'm not sure we need to do.

All of this.

And then you have a baby who's born via C section, so she misses out on that important passage through the birth canal and the seating of her body, of her little body with all those important microbes. And then because I had a fever, they put my daughter Sydney in the nicque the neonatal ICU just for precautionary measures. And again that's all good because they don't know if my fever means an infection that could have been transmitted to her. But what I didn't realize is they also gave her two doses of an intravenous antibiotic just in case, so whatever few little microbes she might have got, you know, gone. And this is where things start to get a little squirrely. And I couldn't figure out why she was sick all the time. I was a first mom. She's the only kid I have, and I would ask other moms. I'm like, oh, well, how many air infections has your kid had? And they're like none, and I'm like, oh, my kid is on her eighth air infection and she's not even one. So she ended up being on twenty two courses of antibiotics before she was two years old. And I realized at that point I had to kind of choose a different path. And really, I always want to tell people that I was able to do it because I'm a physician, and so I know that you know, what are the signs and symptoms to look for I do not recommend that people go rogue and decide to stop going to the beat attrition or stop you know, giving their kid antibotics. But I really do strongly advise that people start asking questions like question number one, is this antibiotic absolutely necessary? And that's the important question to ask, not just for your kid, but for yourself. Question number two, what would happen if I didn't take an antibiotic? Because a lot of the time the answer is, Oh, you'll just be sick for a day or two longer, And it's like, oh, really, oh, I'll take that.

So how do you determine that?

Because like, if you have like I felt like a six year old, but I got strep throat last month and I needed that antibiotic, versus if you have a sinus infection, sometimes you feel like you need the antibiotic, but really you can wait it out.

It's just really tough.

Yeah, it's important to also think about the flip side of antibiotics. When you take an antibiotic, it doesn't just kill off the bad bug causing the sinus infection or the strip. It kills off droves of your healthy bacteria. And in fact, the studies say, it can remove up to a third of your gut bacteria. There is no probiotic in the world that can fix that, and so you have to balance that. It's not like, oh, there's no risk, there's huge risk. And there's several great published studies. There's a study looking at rotavirus and children, which is a common virus that causes diarreal illness. This study showed that children who received a course of antibiotics in the two weeks before they got rotavirus were much sicker, They had more serious infection, more likely to be hospitalized, longer course of illness. We have studies now showing that antibiotics and middle aged women are linked to cognitive decline aging the brain three to four years. We know that antibiotics in young children are linked to poor executive function cognitive issues. So it's not just the theoretical risk of an autoimmune disease down the road. When you take an antibiotic, it is always always doing some damage to your gut.

Your gut is always taking a hit.

And I just go into all the different pros and cons because I want to be clear, this is not an easy decision. It's not you know, antibiotics are terribly you should never use them, or antibotics or panacea you should always take one. There's a lot of grey zone. It's very nuanced, and it's really important that your individual history is a part of that decision making. So, you know, not suggesting that you confront the doctor like hey, I'm not taking an antibiotic no matter what that stuff as poison, but that you really, you know, you have good questions to ask so that you can make a good informed decision together.

Yeah.

As I'm hearing you speak, it sounds like you yourself had this awakening or enlightenment about the over prescription of antibiotics that we see in traditional medicine. You have a medical degree in gastroentrology, You were a physician for many years, probably working in some of these same traditional conventional medicine circles, and now you run a digestive wellness center that is an integrative practice. Describe like what went into that pivot and that awakening.

Yeah, you know, this is it's good. We can do some therapy on this. I'm like, yes, it was. I mean, I it's exactly as you said, Simone, and I like, I trained at good places Yale and Columbia and Mount Sinai, and I was on the committees. I've written textbooks and book chapters, and I considered myself a really good doctor. And really that experience with my daughter of seeing the profound effect of the antibiotics, not just the circumstances of the birth, the C section, but the profound effect of those antibiotics and how they actually made her more susceptible to infection. And because I have the incredible privilege in my practice of treating primarily autoimmune gut disorders like crohnes and ulster kalitis, celiac disease, things like that, I started to take note, and I started to ask my patients about their medical histories, and I started seeing very similar histories. So all of that led to this awakening, and it really, you know, I don't want to describe it as losing your faith because that sounds.

Overly dramatic, right.

I Mean, I am a proud physician, I wear that white coat, I have a prescription pad. I'm very proud of being a doctor. But it really made me realize that a lot of the things we're doing in medicine are creating illness. It's not that we're not doing good. We're doing a lot of good. And antibiotics are life changing antibotics. Over the one hundred years since we've had them, almost have saved millions of lives.

So that's true.

And what's also true is they are widely overprescribed and overused. And what's also true is they are linked to chronic conditions that we are only now learning about conditions not just in our gut, but on our skin, in our brains, et cetera, because of that connection between the gut and these other organs. So these three things are all true. At the same time, it's not all good or all bad. And so for me realizing that, like I'm focusing on prescribing drugs and I'm not looking at what people are eating and how they're living and their habits, and so that really forced me to embrace an additional type of medicine, which is the idea of diet and lifestyle. And I'm really proud that in our practice with our autoimmune patients who have crones and ulster colitis, we have data showing a seventy nine percent remission rate using a food as medicine approach. Now it's not one hundred percent, right, seventy nine, so about four out of every five patients. But the most potent immune suppressing drug isn't even fifty percent. And by the way, it can cause cancer and serious infection. And if you can achieve those same results for similar results using diet and lifestyle, then why wouldn't you, Right, So it's not either or it's both, but trying to build on that platform.

We've got to take another short break.

We'll be right back, and we're back with doctor Robin Chuckin. So I'm curious about some of those lifestyle changes that we can make. What are the best things we can do for our microbiome.

Well, I like to sum it up with sort of an oversimplified three words dirt.

Sweat, veg.

So we'll start with a vedge, actually, because that's the most important one. So our healthy gut microbes ferment fiber. They take fiber and process it in the colon, and they produce metabolites what we call post biotics, things like shirt chain fatty acids and those substances. Those post metabolites are essential not just for maintaining a healthy gut lining, but high levels of short chain fatty acids equal a healthy immune system, so they're important for protecting us from infection, cancer, et cetera, as well as maintaining the health of the gut. So in order to have high levels of short chain fatty acid, you got to eat your vegetables.

So what are the specific vegetables that are great for our gut.

So really there are no bad vegetables, but the ones to really focus on are the really fiber stringy one so think of like broccoli and asparagus, and salary leafy greens are good too, and those are really important. And one thing when you cook broccoli, you don't want to throw away the stem. The stem is where most of the fiber is, so you want to chop up that stem, shave it, do whatever you need to do so that you can cook it and make it more palatable. Same thing with the asparagus. Don't snap off the bottom half of the asparagus because that's where most of the fiber is. And what we call resistant starches are really important too, Resistant meaning they're not broken down in the upper part of our small intestine. So those would be things like in oats and beans and so on, because they float down to the colon where they get fermented by the bacteria. So all the kind of fiber things that we don't digest well because they're really not there for us. They're there to feed our bacteria. Those are really important. And then the dirt and sweat are just you know, getting outside of nature because other than food and that initial passage through the birth canal, where do we get our microbes from. We get them from soil. They're out there in nature in dirt. So we want to have exposure to nature. There's a study that shows that kids who live in a very urban environment, places like New York City where there's a lot of glass and concrete, have higher rates of asthma, they have higher rates of exzema and colonization on the skin with some staff and other bacteria that are not so helpful, and a lot of that is because of the lack of exposure to nature. There's studies that show that rurality, meaning exposure to farm animals and being out in farmland areas, is protective against autoimmune diseases. And so even if you do live in New York City, take your kid to the park, sit in some grass, so that's a dirt, and then the sweat part, because we know that exercise has a really beneficial effect not just on the gut microbiome, keeping it balanced, because it keeps things moving through so you don't get stasis of the contents, but also on gut motility and enzyme secretion, which you want for good gut function.

So some of the people we see.

With the worst GI problems are sedentary people, for example, in nursing homes or people who aren't moving. They get constipated, they have what we call dyspiosis and sort of imbalanced microbiome, have all kinds.

Of motility issues. So there's lots to do.

I mean, hydration is important, There's so many things, But I believe in focusing on three things at a time, and so if you have to focus on three things, focus on dirt, sweat, and ven.

I'm really curious to ask you about all these different probiotics prebiotics that are out there. I'm curious to hear what you think about that and just if there are any that you would recommend that are highly effective.

Sure, So let's start with a quick definition for people who might be a little less familiar. A prebiotic refers to the food that the bacteria eat, So that's all the fibers stuff I was talking about. Right, Biota means organism, let's say micro bacteria for the purposes of this conversation. So prebiotic is something that is feeding the bacteria. And so prebiotics, I like to remind people, are not things that come at a canister with a label from the factory. Probiotics are actually foods out there in nature, like oats and celery and beans and all those high fiber foods. That's a pre biotic. A probiotic refers to the actual bacteria, not just a store bought wandes in the canister, but the ones in our body. And probiotics, the definition from the World Health Organization is a living organism that, when ingested, confers a benefit to the host. And it's the second part of that definition that's tricky because the vast majority of those products out there don't have any efficacy. They can't show any actual data that this is making you healthier. So that's a probiotic. And then a post biotic is what I was talking about. The short chain fatty acids. Those are metabolites that the bacteria make that are ostensibly good for us. And so the first point I want to make, and I relate to this because I was not a good vegetable eater growing up, and even now, my preferred way to get in a lot of vegetables is a green smoothie. But people will do anything to avoid actually eating a vegetable. I feel like when people ask me about a probiotic, I feel like if I say, you know, there's legitimacy for this is and that I'm getting them off the hook for going out and eating some vegetables. So the first thing I want to say to you, my best advice is to feed the bacteria that are already in your gut, because they are alive.

When you buy something off.

The shelf, remember this is an on regulated market. The product says at the bottom, this product is not intended to treat or cure any disease. And in the words of Maya Angelou, when someone tells you who they are, believe them. So you're taking a product that on the label tells you right up front, this isn't going to do anything. But we're taking it anyway because you know, we want to believe the best thing to do is to not kill off your microbes.

With the antibiotics, acid blockers, et cetera.

And to eat the food, the prebiotic food, the beans and greens and broccoli, et cetera, and berries that we know are going to feed the bacteria in our gut. But if you were to ask me, the probiotic that I recommend for certain conditions, because there are over one hundred scientific articles actually showing that it does what it says it's going to do, is something called viz bio, and it's a combination of seven different bacteria, and it is considered by the FDA a medical food for the treatment of conditions like irritable bowel syndrome, for something called pouchitis, which is something that can happen with ulster of klitis after the colon is removed. There's several veterinary studies, but I don't recommend that the average healthy person who wants to be healthier necessarily take a probiotic. I recommend dirt, sweat, veg for that person. You're going to get a lot more bang out of going to the farmer's market, buying some food that was grown in dirt and eating some vegetables.

Doctor Chekin, thank you so much for joining us on the right side.

Thank you so much. That was so informative.

Oh, it's such a pleasure to be with you. Thanks for all the great work and conversations you're having.

Doctor Robin Checkkin is a gastro entrologist, author of several digestive health books, and host of the Gut Bliss podcast.

That's It. For today's show, tomorrow, we're joined by chef, restaurateur and cokebook author Ozma Kahn. She's igniting a revolution in the culinary world, and tomorrow she's sharing her recipe for change with us. Thank you to our partners at Coligard, the one of a kind way to screen for colon cancer in the privacy and comfort of your own home. Talk to your doctor or healthcare provider, or go to coliguard dot com slash podcast to see if you're eligible to order online. If you're forty five or older and an average risk, ask your healthcare provider about screening for colon cancer with Coliguard. You can also request a Coliguard prescription today at coligard dot com slash podcast.

Listen and follow the bright Side on the iHeartRadio app, Apple Podcasts, or wherever you at your podcast.

I'm simone Voice.

You can find me at simone Voice, on Instagram and TikTok.

I'm Danielle Robe on Instagram and TikTok.

That's r O B A. Y See you tomorrow, folks.

Keep looking on the bright side.

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