What Nobody Told You About Your Gut

In this episode of the Health Optimization Medicine Podcast, Dr. Scott Sherr, Dr. Jup Kuipers, Dr. Allen Bookatz, and Dr. Ted Achacoso explore:

• How does the gut microbiome influence mood, anxiety, depression, cravings, and overall brain function?
• Why is the “gut-brain axis” now understood as a far more complex gut-microbiota-immune network?
• What role do the vagus nerve and parasympathetic nervous system play in digestion, inflammation, and gut resilience?
• How can dysbiosis, diet, antibiotics, and chronic stress disrupt the microbiome and contribute to long-term health issues?
• Why does Health Optimization Medicine approach gut health through systems biology, metabolomics, and personalized testing instead of symptom suppression alone?

What We Discuss:

00:00 Introduction: The Gut-Brain-Enteric Microbiota Axis
02:00 Treatment-Resistant Depression and Dysbiosis
04:21 The Vagus Nerve & The Sympathetic Spiral of Doom
09:20 The Gut Ecosystem: Competition and Cooperation
11:03 The Holobiont: Trillions of Aliens Inside You
15:15 How to Nourish the Gut & Reversing Dysbiosis
24:26 The Second Brain & Wrap-Up

Full Transcript:

[00:00:00] Dr. Scott Sherr: Everybody, and welcome back to the Health Optimization Medicine podcast. We're live in studio recording in DC. We're so excited to be with you. We have Dr. Jup, Dr. Allen, and Dr. Ted, of course. Today, we're gonna be talking about what nobody told you about your gut. And the first question is for Dr. Ted, is when a patient comes to you with depression, anxiety, or brain fog And this psychiatrist has already tried multiple medications.

[00:00:58] Dr. Scott Sherr: Where do you start [00:01:00] looking and why? And why is the gut such a big part of this, Ted? 

[00:01:03] Dr. Ted Achacoso: Yeah. I ask the patient or client, "What are you eating? And why is that?" You know? Uh, there's a saying you are what you eat, and the reason is that the gut microbiota actually pre-process all of your food. So everything that you eat is actually pre-processed by the gut microbiota before they even enter your body.

[00:01:24] Dr. Ted Achacoso: So that's my initial question that I ask. Well, we know there's been lots of studies over the last several years where we're absolutely positive that there's gut micro- microbiota challenges with so many out there that are associated with things like schizophrenia, depression, bipolar. And so, well, why is that the case, right?

[00:01:43] Dr. Scott Sherr: Because there's this axis that we've heard of before. We've typically called it the gut-brain axis, but there's something missing there. Yep. What is that missing part, Dr. Ted? Well, this-- I don't know if this study when it was done, but wasn't there a study done on, on twins where one was depressed [00:02:00] and the other wasn't, and they gave them microbiome transplant?

[00:02:03] Dr. Jup Kuipers: So they transplanted the microbiome of the twin that had depression to the healthy twin, and he became depressed, and the other twin- Yeah ... became as happy again. Skinny mice and the fat mice too. Yeah. We've done those too. So that's what you're talking about the missing piece, which is the microbiota itself, right?

[00:02:18] Dr. Scott Sherr: Yeah. So it's not just the gut lining and the brain hanging out. Mm. It's also the microbiota as well. And there's also this other aspect which Dr. Ted likes to talk about in his lectures called interkingdom crosstalk. So you have this, the microbiota, they're not only communicating with each other, they're communicating with our cells by these vesicles and, like, talking to our mitochondria.

[00:02:40] Dr. Scott Sherr: And so there's this huge axis, and so that's why it's called the gut microbiota immune- Brain axis ... brain axis. Yes. Yes, exactly. So I almost got it right. Mm. Yeah. 

[00:02:51] Dr. Jup Kuipers: You sure it got far enough? 

[00:02:52] Dr. Scott Sherr: Yeah. I mean, it might be right now. That's it. I spent a couple days in DC, so I don't know. 

[00:02:56] Dr. Allen Bookatz: Something, something interesting, uh, we just-- So [00:03:00] I still work in acute care, and one of our residents, we, we just started a psychiatric residency, and as part of it, they have to do scholier- scholarly projects and research.

[00:03:10] Dr. Allen Bookatz: And one of my psych residents, uh, that was rotating approached me and said, "Hey, I have a really novel idea that I wanted to do a p- a poster on." And the last several months, she actually did a poster on patients that came in that had treatment-resistant depression, schizophrenia, mania, and got approval for a grant to actually do-- It was just a simple test of dysbiosis.

[00:03:32] Dr. Allen Bookatz: There was no, like, reinforced treatment arm. But what she found was that nearly 100% of those patients that had treatment-resistant mental health disorder had dysbiosis. And again, she-- You know, we ran out of funding, so we couldn't really do additional studies. But, um, what we do know is-- Right, what we do know is that the gut is the largest repository of serotonin receptors, right?

[00:03:59] Dr. Allen Bookatz: [00:04:00] And even more so than our-- Oh, even more so than our brain. Ted, did you wanna- 

[00:04:05] Dr. Ted Achacoso: Yes, sir. Okay. So what he's saying-- It's now on tripartite axis. Before it, we, we just said the, the gut-brain axis. Now it's the gut-brain-enteric microbiota axis. It's tripartite axis. Another thing in addition to what, uh, Dr. Alan Liera has been saying is that there's also another study that was done where, you know, they were giving oral cancer drug to patients.

[00:04:29] Dr. Ted Achacoso: Right. Yeah, yeah. And then they wouldn't work in some. And when they tried to, uh, assay the microbiota, they found out that the, those who were non-responsive were actually lacked two species of, uh, of bacteria. And when they added those, you know, the, the patients became, uh, positive for response. And that's why I actually look at RCTs or randomized controlled trials, trials, as really you cannot control your gut microbiota, and that's always [00:05:00] been my thing.

[00:05:01] Dr. Ted Achacoso: I mean, RCTs are really good for acute care, right? But not for chronic diseases like, uh, like the cancers that you're talking about. 

[00:05:09] Dr. Scott Sherr: That's the big one you always talk about is that randomized controlled trials, why do they change their data every five to 10 years, right? 

[00:05:15] Dr. Allen Bookatz: Or, or maybe we need a new treatment.

[00:05:17] Dr. Allen Bookatz: We need, we need another arm that's studied that looks at a subgroup of those that have dysbiosis and those that don't, and then from here we'll find... But again, that harder to do. But those, for those researchers out there, put that in your, uh, you know- Yeah. Yeah. One thing that gets talked about a lot in here is the vagus nerve specifically, and its importance when it comes to digestion and optimizing your gut microbiota.

[00:05:44] Dr. Scott Sherr: What do you guys think about the vagus nerve? Is it more to go to Vegas and everything that stays in Vegas, kind of Vegas? Or what kind of vagus nerve are we talking about? 

[00:05:53] Dr. Allen Bookatz: Oh, the thing that when you're doing like a cut down the neck and you say, "Do not cut this or else the patient will die." [00:06:00] Yeah. That, that vagus nerve.

[00:06:01] Dr. Allen Bookatz: We know that in order for us to-- Right, we have the-- Well, let's, let's back up. We have the autonomic nervous system is what we're referring to here. Yeah. And we've all heard that we have the fight or flight response, which is the sympathetic component. Fight, flight, or freeze. Flight, fright, or flight, freeze, fright, or are you freezing right now?

[00:06:24] Dr. Jup Kuipers: Are you freezing? 

[00:06:25] Dr. Allen Bookatz: It's an added glitch, you know? 

[00:06:27] Dr. Allen Bookatz: Need some more microbiota check here. Yeah, that's not ideal. Well, I haven't fed them this morning, so they're, they're, they're hungrier. Nice. Speaking of what we're really controlled by here, um, me. And, and then we have our, our parasympathetic system, which is our rest and digest.

[00:06:43] Dr. Allen Bookatz: And so when we talk about the vagus nerve, that-- we're really talking about the parasympathetic nervous system. And I believe you have a phenomenal lecture for those that have not reviewed it. And go find Scott, type in the sympathetic spiral of doom. Is that the one? Yes. It has music afterwards. Dun, dun, dun.

[00:06:59] Dr. Allen Bookatz: So [00:07:00] the vagus nerve is something that is governed by things like our state of relaxation. It's governed by our respiratory rate, our tidal volume, like how deep we're breathing, where we're breathing from. Most of us are breathing high in our chest. Most of us are trying to suck in our guts because we're trying to, you know, look good and not have, you know, our belly sticking out, which is not a, not a typical great look.

[00:07:21] Dr. Allen Bookatz: So, but when we're thinking about digestion and we think about getting to this state, those are all really important to allow us to actually embrace digestion and we're talking about the gut, digestion as a whole. What you're really talking about is that the vagus nerve sort of is your driver of parasympathetic tone outside of your brain.

[00:07:38] Dr. Scott Sherr: Right. And it's the innervation of the gut using the vagus nerve or vital vagus nerve, and it's a bidirectional flow. So there's flow- 

[00:07:45] Dr. Ted Achacoso: Wait, wait, wait. Can we do board exam question. What number of, uh, cra-- What's the number of vagus nerve in the, uh, brain?

[00:07:53] Dr. Scott Sherr: Is it 12? 

[00:07:54] Dr. Ted Achacoso: 10. 

[00:07:54] Dr. Scott Sherr: 10. Yeah, 10. 

[00:07:55] Dr. Ted Achacoso: And it's the longest, right?

[00:07:57] Dr. Ted Achacoso: Yes. Because it traverses all the different [00:08:00] body parts all the way down to the- 

[00:08:03] Dr. Scott Sherr: Reproductive ... 

[00:08:04] Dr. Ted Achacoso: Gonadal It's different things to the different organs, but it's always parasympathetic. And the only organ that doesn't receive any parasympathetic innervation from the vagus is The adrenal gland. Oh, right. One second I added that.

[00:08:20] Dr. Allen Bookatz: That's good. Yeah. That's good. 

[00:08:22] Dr. Scott Sherr: The adrenals. 

[00:08:22] Dr. Allen Bookatz: Yeah, it was funny, right? When we, when we checked for cranial nerve 10- Mm-hmm. Um, what do most people do when they are nervous as a self-soothing mechanism? They might, you might hear them hum, right? Yeah. That is actually a, um, an adaptive response to calm and try to flip, try to actively stimulate the vagus nerve to find themselves in a parasympathetic.

[00:08:46] Dr. Allen Bookatz: So when, when we're humming or we're singing, those are signs. 

[00:08:50] Dr. Ted Achacoso: But, but if the humming is out of tune, does it still count? 

[00:08:54] Dr. Allen Bookatz: Well, for me, if it's out of tune, then I'm... Sing like nobody's listening. And so, yeah, if you're singing, you're humming, [00:09:00] you're, you're humming. I'm like, 

[00:09:01] Everyone: I'm hungry. I'm hungry? Yeah. Yeah.

[00:09:04] Dr. Scott Sherr: Well, I think what it comes down to is that if you don't have vagal tone, if you're in sympathetic all the time, there's no way you're gonna be able to digest all of your food simply because you can't get enough blood flow to do it, right? That we are supposed to be able to calm down so our vagus nerve is inter- is, is activated and so that we get enough splanchnic and additional blood flow going to the intestines themselves.

[00:09:27] Dr. Jup Kuipers: But you can also flip it around, right? So if your gut is inflamed all the time, you're getting a signal to your brain that the world is a hostile place, so you're just stressed out all the time. Your gut is a way for the body and your cells to sense its environment around, around us, and it, it adapts to that.

[00:09:47] Dr. Jup Kuipers: So if it's hostile, if your gut's inflamed, all our cells think the outside world is, is a bad place and 

[00:09:54] Dr. Ted Achacoso: I don't know what world you live in. My world is not hostile. No kidding. 

[00:09:59] Dr. Jup Kuipers: It's very [00:10:00] hostile. Well, now take over. You make me lose my train of thought. So go.

[00:10:10] Dr. Scott Sherr: I mean, look, we're trying to have non-hostile environments- ... as much as possible. And one of the things that, you know, we get asked about with our patients a lot is, you know, about these trillions of microbes that we have in our gut. Mm. And Ted, I, I love the way you describe the gut oftentimes as, well, I guess the skin as being a reverse gut, right?

[00:10:29] Dr. Scott Sherr: Yeah. In that capacity. Maybe talk a little bit about how you message this to your patients and talk about how, what a healthy micro- microbiome actually looks like and what it-- versus a dysbiotic one and how this kind of manifests in various ways. 

[00:10:42] Dr. Ted Achacoso: So, um, the way I talk about this with my patients is, uh, in the concept of balancing.

[00:10:48] Dr. Ted Achacoso: I tell them it's like an ecosystem of its own. Mm-hmm. And of course, I have to describe what an ecosystem is if they don't understand, right? However, they do understand very quickly, uh, you know, uh, because, uh, when I tell them [00:11:00] like if there's a, a significant number of organisms in there, uh, two kilos that are in competition with each other, they compete and they cooperate with each other.

[00:11:11] Dr. Ted Achacoso: Mm-hmm. Right? And therefore, if you imbalance one, the competition will increase or, uh, uh, or the cooperation between two species will increase, and then that will totally imbalance the system. Mm-hmm. Um, an example of that is of, of course in a forest floors, right? In a, in a forest there's a competition for sunlight, for example.

[00:11:30] Dr. Ted Achacoso: Mm-hmm. But there are species that don't like sunlight So, uh, it's the same thing, uh, as in the gut. So when, when, uh, I explain that to, to patients, they begin to understand that I, I start with, "Hey, your, your gut microbiota actually pre-process everything that you eat." And that if you have an overgrowth of one, like for example, the tricarbophylls, they, they're very efficient at processing glucose, then you will be very efficient at processing glucose.

[00:11:56] Dr. Ted Achacoso: And the reason why you're having, uh, uh, an increased [00:12:00] number of tricarbophylls is you're eating a lot of refined sugar. And then eating a lot of refined sugar, you could see your actually fasting blood glucose is here, and then you see fasting blood glucose, oops, your insulin resistance is up, and then you see your HbA1c and you know you have not been eating well in the last few months.

[00:12:17] Dr. Ted Achacoso: So you actually go and, and trace it from the beginning, right? Uh, and the beginning is sort of your microbiota hour. 

[00:12:25] Dr. Scott Sherr: Yeah. And like that. 

[00:12:26] Dr. Jup Kuipers: Wouldn't it be nice if we could measure how your gut microbiome looks like? 

[00:12:31] Dr. Scott Sherr: Yeah, we're getting there. Good first shot. 

[00:12:32] Dr. Allen Bookatz: Hold this in. 

[00:12:33] Dr. Scott Sherr: Yeah, go ahead. 

[00:12:34] Dr. Allen Bookatz: This also jumps into the major framework shift that in health optimization is-- that we talk about.

[00:12:41] Dr. Allen Bookatz: So for someone who comes in and is having anxiety or just gut issues, they, you know, we're gonna send them to the GI specialist or the psychiatrist, and those clinicians are gonna look at their patient in front of them through the lens of the psychiatrist. So- Right ... [00:13:00] only focus the, the brain, the mind, what could you from cognitive behavioral therapy.

[00:13:04] Dr. Allen Bookatz: The GI specialist is gonna focus on- Scope them ... sort of like diet, but yeah. Scope them. Scope them up and down. Let's scope them. Let's get them on, on a PPI, um, which will, you know, unfortunately off Dr. Ted over here. But in health optimization, we move from the level of the organ to looking at the body as a holobiont, and maybe Dr.

[00:13:27] Dr. Allen Bookatz: Jup can tell us what a holobiont is. 

[00:13:29] Dr. Jup Kuipers: The holobiont is, uh, a way of looking at who we are as a person, not as just one organism, but actually a collection of trillions of cells, uh, in a network, uh, which are made up of different species of cells from the animal kingdom. So we have our own human cells, like monkey DNA.

[00:13:51] Dr. Jup Kuipers: We have our mitochondria, uh, which are endosymbionts actually, and we have our microbio- microbiome, all the bacteria in our gut, on [00:14:00] our skin, and as we now know, also in our bladder and other places in our body. No place is sterile. No place is- You're saying some places are sterile. No, not sterile ... and, and molecules from your environment, your internal environment, your external environment like pollutants.

[00:14:13] Dr. Jup Kuipers: And all these molecules, they, yeah, they communicate in a network. Um, and that is actually who you are, what you call your metabolic phenotype. Um, uh, I always find this fascinating to think about. So- All your microbiome, your microbiome partners, their genetic DNA is 100 times larger than your human DNA. So we think of ourselves as this monkey, but it's actually more of all these alien, trillions of aliens in and around us are more you than the monkey.

[00:14:48] Dr. Scott Sherr: Who is running who? 

[00:14:49] Dr. Allen Bookatz: I mean, to your point, what Dr. Ted was probably gonna say is that, is that when we look at-- We, we know the human body is a network of organs and [00:15:00] various systems that are networked. And as we expand our framework shift, understanding that we are this multicellular organism, and we're an ecosystem of different ecosystems, not just human, but microbiota and others, that we really need to rethink our gut microbiota as not something just separate.

[00:15:19] Dr. Allen Bookatz: But as Dr. Ted refers to, it's a, it's really a postnatal organ. And when you really let that sink in for a moment, that means it's just as important as your heart, as your kidneys, as your liver. So if you take out any one of those, I mean, you, you die. You can't survive. So, um, and we know that if we wipe out our microbiota or we don't have a healthy, uh, commensal flora, then, you know, we may not die immediately, but our chance of survival and our resiliency is significantly diminished 

[00:15:59] Dr. Ted Achacoso: It's so [00:16:00] nice to listen to my students-

[00:16:03] Dr. Ted Achacoso: finally internalizing all of this. Especially someone who have a in acute care- Yeah. Uh, in emergency care. Um, but, uh, yes, it takes a while. Like it took me, actually, even I, it took three years to actually shift my perspective, and I was someone who founded the framework, right? Um, the-- what I was going to say is that a friend of mine who founded the World Microbiota Society in Europe actually asked me, he said, "Ted, who do you think rules us?"

[00:16:33] Dr. Ted Achacoso: He says, "Do we rule over the microbiota or, uh, do the microbiota rule us?" And so, and he's just answering his own questions. I think we're just dependents of the microbiota. And he's like, "They use us for food, you know, they determine how we, how we feel and everything else." And, and he said, "And when we die, they're still there."

[00:16:55] Dr. Ted Achacoso: So- So, so you know, [00:17:00] that flips the, the issue. We, we look at the, the microbiota as opposed to have organ, but for him, it's just like, no, no, no, they're actually a separate, uh, entity that rules us. And we're, we're, we're, we're just, we're just the, the, the father for their food, right? The vessel for now. The...

[00:17:16] Dr. Scott Sherr: Yeah, I mean, this goes into the conversation, I think, more about how we nourish the gut in general, and then how we can look at this from our lens as the gut-immune system, as we think about it, and as we have been taught by Dr. Ted, and then in our modules that we have at homhop.org. Um, when you get questions from your patients about restricted diets or what they should eat, what they shouldn't eat, how do you navigate this?

[00:17:41] Dr. Scott Sherr: Yeah. Is it let's just take everything out and see how you feel, or you're looking at data probably and going from there, right? Probably, yeah. So- Go for the blueberry diet. Blueberry diet. Absolutely. Now, everything we do or ideally do in clinical practice is based on, on a measurement, 'cause otherwise you [00:18:00] don't know what you're doing.

[00:18:01] Dr. Jup Kuipers: And the pattern I have seen so many times now is especially in like vegetarian people, they think they eat very healthy, but all the, now all the green, leafy greens and the, the, um, starches, they just sit there fermenting in their gut- ... cause these microbes to flourish but produce all this metha- methane gas and bloating.

[00:18:26] Dr. Jup Kuipers: And people think like, "Oh, more is better. Am I eating healthy?" But actually they're ha- they have bacterial overgrowth, and we can now measure these things. Like what strains of bacteria is there overgrowth, and what does the population of bacteria actually look like? And then you can, can come up with, uh, targeted advice on maybe don't eat as much starches or, um- fast some more so your body doesn't have to, uh, uh, ferment so much food.

[00:18:56] Dr. Jup Kuipers: And you can look at things like, uh, food [00:19:00] sensitivities, um, to actually be informed of what kind of foods trigger a reaction and what kind of foods don't. 

[00:19:07] Dr. Ted Achacoso: Yeah. Was there a case, uh, here in the United States of a guy who was stopped for drunk driving and, you know, his, his alcohol level were up and he, he swore he wasn't drinking, right?

[00:19:21] Dr. Ted Achacoso: And it was actually because his gut microbiota was fermenting so... He did. And so he actually was having, um, you know, uh, alcohol, uh, related symptoms. But, uh, you know, it was only after they did an investigation that they came up, okay, he's actually just going to jail for drunk driving. Wow. 

[00:19:45] Dr. Jup Kuipers: We, we can measure these things now for our clients.

[00:19:48] Dr. Jup Kuipers: And, um, the gut does so much more than just digest. It, it has to digest your food, but you have to be able to absorb it, um- Your gut [00:20:00] is your primary immune system, your barrier against invaders from the outside world, so it has to have a properly functioning immune system. We can measure are there signs of inflammation?

[00:20:11] Dr. Jup Kuipers: Um, we measure dysbiosis, so you can measure your whole microbiome, so the total quantity of microbes, and also what does that community of microbes consist of? You know, basically sending big families of microbes, and we can measure how far off are these from a healthy cohort. Uh, as we said, these bacteria, they pre-process all your food to produce vitamins and minerals, so they have a big metabolic function, like producing short-chain fatty acids in their- And we ca- we can measure this in your, in your stool, actually.

[00:20:43] Dr. Jup Kuipers: And we see there are things like infections, like parasites or pathogenic bacteria that might be causing an issue, um, and then come up with very targeted protocols to actively address what's right, what's wrong. So we demystify [00:21:00] or make insightful and actionable this whole microbiome rainforest analogy we we've been talking about, uh, to make it actually clinical, clinical and practical for our patients to- 

[00:21:14] Dr. Ted Achacoso: Yeah, as a, as a quick guideline for clinicians here, uh, really the tripartite axis of the gut-brain-enteric microbiota.

[00:21:24] Dr. Ted Achacoso: There are ways of communication that are known. One is the biggest nerve, uh, so that's nervous, uh, system communication. Remember, com- communication is bidirectional, right? And then the, uh, and the second one would be, uh, through the hormonal system like ACTH, right? So when you're stressed out, when you're nervous, exactly, you get butterflies in your stomach and all those kinds of things, right?

[00:21:46] Dr. Ted Achacoso: Mm-hmm. Uh, and then there is, uh, the, uh, the other one is by the immune system, right? They produce, uh, all of these molecules that indicate whether or not the gut is under attack and, [00:22:00] uh, you know, yet the g- the gut has been trained to... Uh, for example, in, in, um, uh, autoimmune diseases, right? Uh, you know, one of the first things I do with them is I actually take a look on their, um, uh, gut microbiota picture, as Dr.

[00:22:16] Dr. Ted Achacoso: Yap here actually, uh, mentioned, right? It's because you, you can see and y- you could usually see some overgrowth and, you know, it-- on the whole picture it does add, uh, it does add to the, uh, decrease in the severity of their signs and symptoms. 

[00:22:33] Dr. Scott Sherr: Yeah. 

[00:22:34] Dr. Scott Sherr: I mean- I think what we're talking about here is if you have data to play with, you know exactly how to target things, as you mentioned, you know.

[00:22:40] Dr. Scott Sherr: And also targeting diet. Sometimes it's people fiber maxing and having- Yeah. ... way too much fiber and then getting drunk, like Dr. Ted said. Other times they're having zero fiber, and they don't have all those other gut bacteria that they need to pre-process their food. And so really I understand that it's difficult to [00:23:00] sometimes get a test because it's, it's expensive.

[00:23:01] Dr. Scott Sherr: You have to find a clinician that you can work with. But as practitioners, if we have this data, we can really help target our patients to what they actually need, and oftentimes, as we said before, subtract the things that they don't. Mm-hmm. And I think that's the big part of it. And so when we're doing this, guys, yeah, how long does it typically take to see meaningful rehabilitation of a gut microbiome?

[00:23:22] Dr. Scott Sherr: Are you seeing this in a couple weeks, in a couple months, in a couple years? What is your experience so far? 

[00:23:28] Dr. Jup Kuipers: Typically, usually three to six months. It depends, in my experience, a bit on how severe, say, a dysbiosis is or a short-chain fatty acid deficiency. S- if you can supplement that, people will start to feel better very quickly.

[00:23:45] Dr. Jup Kuipers: Say they have leaky gut and you supplement with, uh, a butyrate or glutamine, they can feel better very quickly. But overall, shifting the population and keeping it stable i- in the, in the right ratios takes, takes [00:24:00] time. And honestly, about three to six months, uh, in my experience, would set a minimum. 

[00:24:07] Dr. Ted Achacoso: Um, there's been a study that was done on, um, elderly adults and, uh, they found out that, uh, you know, within about 72 hours of a different diet, the ratios actually start flipping, right?

[00:24:23] Dr. Ted Achacoso: So, uh, for example, if you're jet lagging or, and are in a different place and are eating a different cuisine and so on, then it, it actually flips and contributes to the dysbiosis of your gut, right? Uh, and then it stabilizes if you are, you know, actually are relocating to that area. So it just shows you that, you know, we started this, uh, with, uh, you are what you eat.

[00:24:47] Dr. Ted Achacoso: It still ends with you are what you eat because, uh, even when you, uh, take a look at the dysbiosis caused by jet lag or moving to another time zone, et cetera, as in, as early as [00:25:00] 72 hours, you can see changes in the gut microbiota. 

[00:25:02] Dr. Allen Bookatz: Something, 

[00:25:03] Dr. Allen Bookatz: something interesting I think we've all, hopefully this is relatable, if we, um, are traveling or we say fall off the wagon for our diet because, you know, we are human too and sometimes we- 

[00:25:15] Dr. Ted Achacoso: Who?

[00:25:16] Dr. Allen Bookatz: Yeah, well, some of us are human. We're all, yeah, exactly. We're all- Who's running who? Who's running who? And, and so you're, you're having a little too much cake and you're, you know, refined sugar, carbs, and you do that for a few days. What do you find that you notice different about what you crave and the type of food choices you make?

[00:25:37] Dr. Allen Bookatz: Um, you're gonna most likely find yourself craving more sugar. And, um, I think it's a testament to the fact that what we eat is feeding, selectively feeding the particular strains of microbiota. And then as those grow and become dysbiotic, then they-- If they're, if they're not being fed via you intaking [00:26:00] those sugar molecules- Mm-hmm

[00:26:01] Dr. Allen Bookatz: then they're gonna secrete stress. Uh, you know, we'd be going back to what we talked about, if the gut is the largest repository of serotonin receptors, then they really hold the key to, you know, your happiness and your mood and your cravings. And so they, um, you know, in terms of who's driving who here, they are gonna dictate and drive your behavior.

[00:26:22] Dr. Allen Bookatz: And so it can take... It's, it's surprising how easy it is to derail a healthy microbiome. Just take antibiotics. That's a good way. Yeah. Yeah. Well, it's, that's actually really interesting. So, you know, as I am still in acute care, one of the battles that we are continually up against is that, um, when patients come in and they have some type of viral illness, there is a, there is a sense that they, they want a pill, they want an antibiotic that's gonna treat them.

[00:26:49] Dr. Allen Bookatz: And, um- Uh, you know, I'll, I'll share how this has changed my practice in acute care is that sometimes you just-- it was easier to give them an antibiotic even if you knew it was a viral and you just move [00:27:00] on. You say, "Yeah, a macrolide or, you know, uh, some from, you know, second-generation penicillin is not gonna harm them."

[00:27:07] Dr. Allen Bookatz: Yeah, and you fulfill your statistics like that. And you just check, right? Move along and get them out and I'm not gonna get a complaint. And now, um, you know, it's made, in some senses, it's made life a lot more challenging because if I really have their best interest in mind and I don't-- and I know they don't have a bacterial infection or I don't think they do, then I am really counseling them on these type of things.

[00:27:27] Dr. Allen Bookatz: I think that is something that for those of us that are still in the illness medicine realm, maybe you have primary care practice or urgent care, uh, emergency, or you're anyone who uses antimicrobials, pharmaceutical grade, you know, it's really something that keeping in the forefront I think is really gonna help you, your practice, the patients 

[00:27:46] Dr. Ted Achacoso: Yeah, I'd just like to, um, say something here.

[00:27:49] Dr. Ted Achacoso: You know, when, um, the whole, uh, gut mo- gut microbiota movement came about, you know, the, uh, famous book is, you know, This is Your [00:28:00] Second Brain. So we look at the gut as actually a second brain, because it can actually function on, on its own. It can still be alive where if you, you already brain dead, right?

[00:28:10] Dr. Ted Achacoso: So, uh, it has its own neurotransmitters, and it can, it actually function on its own just as a separate organ. And, uh, as far as, uh, you know, the, the serotonin that's produced in your brain, this is actually go by a different pathway. You know, don't confuse the two. There, there are what's called large neutral amino acid transporters in the brain for, uh, tryptophan, right?

[00:28:31] Dr. Ted Achacoso: And so-- and those are the ones converted by the brain. So as much as 92% of your serotonin is actually produced in the gut, produced by the gut, right? Uh, the third, uh, thing that I, uh, had a picture of, which I was trying to, uh, say earlier is like if the, if we are like the tenants of the, um, uh, of the microbiota, it's like imagine us lying down and then this blob of microbiota just crawling around us.

[00:28:59] Dr. Ted Achacoso: It's like, [00:29:00] "Let's eat up this sucker. Whee!"

[00:29:05] Dr. Scott Sherr: It gives you a different perspective on who's eating who. Well, guys, I think we'll wrap this one up. Um, it's a really nice episode. I hope for all of you to get an understanding of how we think about the gut. I mean, there's lots of different things you can go out and do. Get your probiotics, get your prebiotics, but have a foundation of all this.

[00:29:24] Dr. Scott Sherr: This is what we do at HOMeHOPe. We have a gut immune system module if you're a clinician. You can learn how to think about the gut as we've been describing it here today with lectures from the faculty. Um, just know that it takes time, right? It's not something that over the first couple of days-- For me, I often see that people get worse before they get better oftentimes.

[00:29:46] Dr. Scott Sherr: If you, if you seal up a leaky gut, then you're gonna see all the manifestation of the growth, not outside the gut, but inside the gut. And so I, I counsel my patients. It may look a little worse before we get better, and that's [00:30:00] okay. Any further comments, anybody? Wow. Isn't that, um, a part of, like, the standard lore for physicians?

[00:30:08] Dr. Scott Sherr: It's like, "Take two aspirin and call me in the morning." Like, it's better to get worse before it gets better. But this time it's actually true, right? Um, that, uh, uh, because, because, uh, Syphon-- Uh, remember there are some, uh, tribes, for example, where Treponema, which is a species of, uh, syphilis, is actually native to their, uh, gut microbiota.

[00:30:30] Dr. Ted Achacoso: It's on scabbing shack. So remember, at any one time, these are co- uh, compete, compete, comp- I'm already-- They are competing and cooperating. Ah. It's nice to have together. Yeah. Network. The species, right? So when you throw them in imbalance, they will push to compete or they will, uh, push to operate. And in both cases, those can actually induce, uh, imbalance in your gut.

[00:30:57] Dr. Ted Achacoso: And remember that your gut [00:31:00] microbiota, the ratios of them are as unique as your thumbprint beginning two to three years old, right? So, uh, this can be measured now and, uh, what is still missing from our current science is that we still cannot do targeted, "Oh, I wanna replace the, only the following microbiota."

[00:31:19] Dr. Ted Achacoso: We still don't have that, right? We don't have, have like custom probiotic for, you know, Dr. Sherr, the, the only replaces. But I think we're going there, right? Uh, we're going there. We have, uh, better, better diagnostics to see this, you know, and, and accounting the pop- doing the population count and developing better statistics now.

[00:31:39] Dr. Ted Achacoso: Um, because these are-- Remember, your-- When they collect your stool, they mash, you know, all of these things together. Have you seen it done? Things. Have you seen it done? It's very, it's like the- So it, it is very dependent on sampling and all of that. But we're developing better technologies to do that. And then of course, there's now AI-assisted reading all of these things, [00:32:00] which, uh, uh, g- has a better estimation, right, of, uh, uh, what's going on in your gut.

[00:32:06] Dr. Ted Achacoso: So, um, you know, don't guess, test. Yes. Right. And, uh, you know, the first thing to ask your patient is like, "What are you eating?"

[00:32:19] Dr. Ted Achacoso: Or what's eating you?

[00:32:20] Dr. Scott Sherr: Or what's eating you? 

[00:32:21] Dr. Scott Sherr: Correct. Thank you guys for listening to another episode of the Health Optimization Medicine Podcast live in studio with Dr. Ted, Dr. Allen, Dr.

[00:32:29] Dr. Scott Sherr: Jup. We'll catch you all next time.

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