Better Health Takes Guts

Dr. Drew Sinatra: Do you have a gut instinct or butterflies in your stomach and you usually pay attention to them, but how much do you really notice how well your gut is doing?

Dr. Steve Sinatra: The wellness of your digestive system has a huge impact on your overall health, from how you think and feel to the health of your heart, brain, skin, joints, and so much more.

Dr. Drew Sinatra: And there are many good ways to take care of it, but there was also lots of mistakes to avoid. We're going to share with you the realities of digestive health today and learn more about the whole microbiome and how to take care of it. I'm Dr. Drew Sinatra.

Dr. Steve Sinatra: And I'm Dr. Steve Sinatra.

Dr. Drew Sinatra: And this is Be HEALTHistic.

Narrator: Welcome to Be HEALTHistic, the podcast that is more than just health and wellness information — it's here to help you explore your options across traditional and natural medicine, so that you can make informed decisions for you and your family. Health isn't a one size fits all approach, everyone has their own needs to Be HEALTHistic.

Narrator: This podcast illuminates the whole story about holistic health by providing access to the expertise of Doctors Steve and Drew Sinatra, who together have decades of integrative health experience. They'll share with you the best that traditional and modern medicine has to offer, so that you could be more productive and more proactive in managing your overall health. Be HEALTHistic is powered by our friends at Healthy Directions. Now, let's join our hosts.

Dr. Drew Sinatra: Hi folks…before we launch into our discussion today, I want to encourage you to be a proactive member of our Be HEALTHistic community. If you like what you hear today and you want to listen to future conversations on all things integrative and holistic health, subscribe to our podcast on Apple Podcasts or wherever you download your favorite podcasts. Also, check out and subscribe to our YouTube channel, which will feature video versions of our episodes plus video extras you won't want to miss.

Dr. Drew Sinatra: And finally, we have more with me, Dr. Drew Sinatra, my dad, Dr. Stephen Sinatra, and other Healthy Directions experts, as well as a robust library of health and wellness content over on the Healthy Directions site. So visit HealthyDirections.com to explore our database of well-researched content and information. And of course, you can always follow us on our social media channels.

Dr. Steve Sinatra: So Drew, it seems more and more today that GI issues are on the rise. Why is that?

Dr. Drew Sinatra: Well, I think it partly has to do with our environment, and how dirty our environment is with toxins and chemicals and such like that. And really, it's a matter of our lifestyle that we live. I think people are living this very busy, modern lifestyle that is encouraging them to be stressed out all the time. I mean really we're all into this enormous amount of stress, and we know that stress can affect the microbiome.

Dr. Drew Sinatra: It's also the foods that we eat. They're not really clean anymore. They're not really real foods. A lot of people are eating processed, sugary foods and the wrong fats. And so there's lots of different factors that go into this — and also medications that patients are taking. So, a new study that came out of Germany showed that 25% of medications affect the microbiome, right? It's not just antibiotics, or corticosteroids, or proton pump inhibitors, or H2 blockers, we have a whole subset — 25% of medications can affect the microbiome.

Dr. Drew Sinatra: So there's lots of different insults, I guess we can say, or assaults that are happening on the microbiome, and it had really has an accumulative effect.

Dr. Steve Sinatra: So what actually is the microbiome? Can you define it?

Dr. Drew Sinatra: Yeah, the microbiome, there's different microbiomes in our bodies. So we've got the gut microbiome, which you know primarily is a composition of bacteria and yeast. There's even viruses, there's protozoa, there's other microorganisms that inhabit, starting off in your mouth. That's really where the microbiome of the gut starts, is in your mouth. It goes all the way down your esophagus. The stomach has its own unique microbiome.

Dr. Drew Sinatra: The large intestine is really where a lot of these probiotics that people consume or probiotics that are in foods, like fermented foods — that's where a lot of these organisms inhabit. So when you think about the large intestine or the colon, that's where we have trillions of these organisms living. I mean in the trillions. Imagine that, right? They say that there's actually 10 times more bacteria and organisms living in our gut than there are human cells. So that begs the question, are we more bacteria or are we more human?

Dr. Steve Sinatra: Sounds like we're more bacteria.

Dr. Drew Sinatra: Yeah, that's true. And I mentioned microbiomes in the other parts of the body, there's a skin microbiome. There's a microbiome of your scalp. There's a microbiome of your eyes, right? Women have a microbiome of their vagina. There's all sorts of different microbiomes in the body. And I focus primarily on the gut microbiome.

Dr. Steve Sinatra: It's interesting you say that, because I've read a lot of information about cesarean section in women, where the child doesn't pass down the birth canal. Can you say something about that as a naturopath, especially — I mean your wife's really involved in the reproductive situations, as well, with women.

Dr. Drew Sinatra: Yeah, well, they say actually that the exposure to microbes really happens in the womb. And when the baby passes through the birth canal, if they do have a vaginal birth, there's an exposure that happens to different microbes, which is really good. You want to have this exposure to mom's microbes through the canal. If you have a C-section, you're not really going to get that exposure and unfortunately, if you're having C-section in a hospital, which is happening all the time, you're going to be exposed to microbes that maybe you don't really want to be exposed to.

Dr. Drew Sinatra: Now, there's a lots of controversy out there. Some docs, some OB/GYNs are actually doing a swab of mom's vagina and kind of passing that along the baby once they do have a C-section — but that is not without risk. So we need to have more research on that before we start recommending that to people. But we know though that babies that do you have vaginal birth compared to C-section, they do have lower rates of certain conditions later on in life.

Dr. Steve Sinatra: Do they have more immune support?

Dr. Drew Sinatra: I believe that they do. If you look at the research, what happens with a vaginal birth is they have the exposure to these microbes, and the exposure is good because it promotes immune tolerance. I think of the immune system as like the heart. It needs to be exercised. You got to have exercise for the cardiovascular system. You've got to have exercise for the immune system, as well. And that first moment when a baby's born, travels through the birth canal, that exposure is beginning the time at which the immune system is developing.

Dr. Steve Sinatra: So it sounds like inflammation in any of its evil forms can present itself, and basically, if you can improve the immunity of the neonate going through, I mean, that's key right now.

Dr. Drew Sinatra: And what's even cooler is if you look previous to this, so let's say you've got a pregnant mom — but if a mom is living on a farm, the more animals that she's exposed to during her pregnancy, the child that she gives birth to is going to have fewer asthma, allergies, and that type of disease, including eczema.

Dr. Drew Sinatra: Now, what does that all about? Right? These animals, right, are covered in dirt. They're covered in mud. They're walking through the woods, whatever it is. I mean, they're exposed to all sorts of microbes — and then the pregnant mom is exposed to these microbes, which then builds immune tolerance for the baby.

Dr. Steve Sinatra: Hey, Drew, that makes a lot of sense to me. I mean, I'm thinking about in my days as a cardiologist and I treated farmers in Connecticut. When I look back on it, and I look at some of the cardiovascular inflammatory risk factors, they were pretty low. I mean, that's interesting. You just gave me something to think about. That is an amazing situation, where if you're walking around all this stuff, these "germs," it's doing something for our immune system.

Dr. Drew Sinatra: It's one of the best supports for the immune system.

Dr. Steve Sinatra: So anyway, I just want to get back to the heart for a second, because that's my specialty. This whole microbiome and this whole situation about probiotics is really amazing. Remember the paper we submitted for publication, about probiotics lowering triglycerides?

Dr. Drew Sinatra: Mm-hmm (affirmative).

Dr. Steve Sinatra: When it comes to triglycerides and the heart, there's very few things that lower triglycerides. Weight reduction will do it, a lower carbohydrate diet will do it. But when I came across probiotics lowering triglycerides, this is an eye opener.

Dr. Drew Sinatra: Well, who would've thought, right? I mean, how can probiotics affect cholesterol, and therefore affect heart? I mean, it's pretty remarkable that this can happen.

Dr. Steve Sinatra: Well, you said it, the gut talks to the brain. Now the gut's talking to the heart.

Dr. Drew Sinatra: Yeah. I mean, there's all sorts of connections in the body. So what we know is that there's this gut-brain access, gut-brain connection. There's a gut-heart connection, there's gut-skin connection, there's a connection with the joints. I mean, you can go on and on and on. And I first realized this early in practice when I would take patients off of gluten or dairy, right? We talked about these foods being problematic for a lot of people.

Dr. Drew Sinatra: And what I found was, let's say someone came in and they're having lots of bloating, and they're having brain fog. They're having some joint pain, and their memory isn't that great. What I would do is take them off gluten, and what I'd see when they come back three weeks later they say, "Doc, my bloating's so much better, but my joint pain went away, and I don't have any brain fog anymore. And my memory is clear. What the heck's going on here?" So that led me believe that, hey, the foods we're consuming can certainly have an effect on your gut, but also have an effect systemically in your body. And that was profound to me.

Dr. Steve Sinatra: So the gut affects the heart, and the brain as well.

Dr. Drew Sinatra: It does. And what we know about the heart is that, there was only one study I read about this, but we do know that there's a condition called dysbiosis, okay, and dysbiosis is really an imbalance of gut flora. And what we know is that there actually is a higher incidence of dysbiosis in certain cardiovascular disease conditions, like heart failure, or coronary artery disease, or kidney failure — or even diabetes.

Dr. Drew Sinatra: So, there is a gut-heart connection. And I think that anyone listening to this that wants to have a say in prevention of cardiovascular disease, make sure your gut's in working order.

Dr. Steve Sinatra: So a key takeaway for the listener right now is to be mindful of their gut. In other words, how can I improve my gut health?

Dr. Drew Sinatra: Yes, and I mean, we'll get into really what we can do about gut health. Why don't we first start off by talking about what could be bad for the gut. Okay?

Dr. Steve Sinatra: Sure.

Dr. Drew Sinatra: Now, we mentioned there are certain medications, there's 25% of medications out there that can affect your gut. So let's say antibiotics, that's the first one that people think of that really harms the gut. And it certainly does, because we've all taken antibiotics in our life and these are life-saving medications, and I prescribe them to my patients — but they are used too much, I believe.

Dr. Drew Sinatra: I believe they're just given out too quickly, especially for certain ear infections when children are actually suffered from a viral condition, not even a bacterial infection. Antibiotics are really indiscriminate killers of bacteria in the body. They're going to kill off the bad guys, but they're also going to kill off the good guys, too. So that gut microbiome that we were just talking about is going to be affected when you take an antibiotic.

Dr. Drew Sinatra: Now another interesting piece that I found, actually I read an article, I think it was back in May 2019, where researchers looked at 72 rivers across the world. Okay? And what they found was that, I think it was over 65% of these rivers had antibiotic residues in them. So it's not just, okay, you take an antibiotic and your gut microbiome is a little disturbed. But really it's like even the water we're drinking sometimes may have trace residues of antibiotics in it. And that's concerning to me.

Dr. Drew Sinatra: And also the foods we eat, right? What about conventional meats, where these animals are pumped up with antibiotics, is there residue that's being passed down from that meat into our bodies? So there's this constant onslaught that's happening to the microbiome, where antibiotics and other substances are affecting it. And even in something as simple as washing your hands with an antibacterial substance. I mean, you walk into any hospital, any sort of — even grocery stores these days, and there's a little dispenser out there that might have an antibacterial sanitizer there. And I think that's too much.

Dr. Drew Sinatra: I think there's this fear of germs in our society, and really, we got to reign that back in. We got to tame down that fear, because we need to have regular exposures to bacteria. And there comes a time and a place for antibiotics, but really, they're overused.

Dr. Steve Sinatra: Yeah, you're making a good point. I mean, there is antibiotic resistance going on. In fact, when people are admitted to hospitals and they get a staph coagulase, an antibiotic resistance staphylococcal, it's very, very serious. There's an antibiotic strain that has, the Klebsiella strain coming out of China, has some antibiotic resistance, as well. And this is something that's on my radar. And if this comes across to America, one of the antidotes is mushroom extracts, the shiitake, maitake mushroom. So if any of our listeners develop us a bizarre respiratory illness and the doctor can't diagnose it, I think one of the considerations would be a mushroom complex.

Dr. Drew Sinatra: That's a great point. And antibiotics are not all created equal, either. I mean there's certain antibiotics, like take amoxicillin, right? It's a pretty gentle antibiotic on the gut microbiome. So if you take it, there's going to be a change, but there's not going to be a major change. But let's say you're developing pyelonephritis, or kidney infection, you've got severe pneumonia, right? You need a little bit of a higher-tier antibiotic like Cipro, right, which is a fluoroquinolone.

Dr. Drew Sinatra: If you take that, your gut is going to be affected for, we know, at least 12 months, okay? So you may not even return to where you were before, because there's been such damage done to the microbiome from using the antibiotic. So if there's any physicians listening to this, be really selective with your antibiotics. Try to start with more gentler ones, if possible. And then move on to the broad spectrum ones, if really needed. Because I do want to reiterate that the antibiotics are absolutely necessary. They're just, in my opinion, sometimes overly-prescribed.

Dr. Steve Sinatra: I think the pearl for our listener is, when possible, when possible, try to support your immune system without an antibiotic.

Dr. Drew Sinatra: Correct.

Dr. Steve Sinatra: But again, you need to talk to your doctor. But maybe through active communication and conversations, you can support the immune system in an alternative way, as opposed to a conventional way.

Dr. Drew Sinatra: Because like you said, Dad, I mean antibiotic resistance is growing and I'm not sure if anyone's really talking about this, but it's going to be a major problem in the next 10, 20, 30 years.

Dr. Steve Sinatra: Oh yeah, no.

Dr. Drew Sinatra: I mean, a major problem. And I'm finding sometimes that people come in with an infection, I give them something, let's say, if I have to get them Cipro, sometimes it's not even working today, and it's scary. So, there's some antibiotics out there that we're finding that aren't working anymore. And what's going to happen when the resistance builds even more?

Dr. Steve Sinatra: Our theme here, Drew, is being productive without being self-destructive. We want to make sure an antibiotic doesn't create self-destruction for our listeners at the same time.

Dr. Drew Sinatra: Exactly.

Dr. Steve Sinatra: So anyway, on this microbiome, I mean, can you give a definition of it that is germane to our listeners?

Dr. Drew Sinatra: What we know is that these little bugs in our gut are doing so many different things. They're actually synthesizing vitamins. So vitamin K, right?

Dr. Steve Sinatra: Oh yeah, oh yeah, right.

Dr. Drew Sinatra: B12, synthesized in the gut. These microflora that inhabit your gut are also helping digest your foods. You need them for that purpose. They're helping support the integrity of the intestinal lining, and they're also acting as anti-pathogenic agents, so to speak. So they're protecting us against the bad bacteria that we're exposed through in our environment, and the food that we're consuming. And it's amazing, though, I mean the genetic potential and the genetic capabilities and such is huge, like you said.

Dr. Drew Sinatra: And I think right now, I mean, we're really at the tip of the iceberg for learning about the gut microbiome and how it influences the rest of the body. I mean, we have a lot to learn.

Dr. Steve Sinatra: So Drew, what does it mean to be regular? In other words, how often should I really be going to the bathroom?

Dr. Drew Sinatra: This is a question I have to debate over sometimes with patients. I think that one bowel movement to three bowel movements a day is considered normal. So when a patient comes in and they tell me, "I have not pooped in two, three, four days — but that's normal for me, so that, that's okay, right?" I say, "No, no, no, no, that's not okay. You need to be going to the bathroom every single day, at least once a day." And there's many different causes for why people have constipation. And some people have loose stools, too. I mean, you got to really address both here — but I do feel that one to three bowel movements a day is the best.

Dr. Steve Sinatra: You know, as a heart specialist, I looked at this, actually, years ago. I mean, the average American takes in about 12 to 15 grams of fiber a day. We need to take in at least 40 grams of fiber a day to really have good bowel cleansing. So as a naturopath, I'm sure you talk to your patients about getting adequate fiber.

Dr. Drew Sinatra: Yeah. And it always starts with diet, right? It always starts with increasing the fruit and vegetable intake. And if they can handle grains, we'll add on some grains. And there are certain fibers that people could take in supplement form, whether that is a ground up flax seeds, or if they want to take ground psyllium husks, or ground up chia seeds. These can all help with constipation or loose stools. And another thing that people forget to do is drink enough water. Hydration — and hydration affects the body in many different ways, but it certainly affects the bowels.

Dr. Steve Sinatra: So let me ask you, how do you talk to your patients about your gut’s connection to whole body health?

Dr. Drew Sinatra: Yeah, it's a great question, and a lot of people are coming in with digestive complaints. I mean, it's common these days, so let's talk about-

Dr. Steve Sinatra: So it's not just constipation, diarrhea and IBS?

Dr. Drew Sinatra: Right. It's a lot more than that. I mean, there's the-

Dr. Steve Sinatra: Are you seeing an immune system dysfunction in some of these patients, as well?

Dr. Drew Sinatra: I think most people have immune system dysfunction, right? And there is a whole connection with the gut, which we'll get into. But yeah, you mentioned some diarrhea, constipation, bloating, abdominal pain. Heartburn is another common GI symptom. And so when people have that, obviously I'm focused on the gut, but I'm also looking at constellation of symptoms across the body, and I try to figure out, well is this connected in some way? Is their headache connected to their constipation, or is their joint pain connected to their bloating?

Dr. Drew Sinatra: And there's all sorts of tests that we can run to figure out if there's a... We talked about dysbiosis, which is an imbalance of gut flora. We can run a breath test, a simple breath test to learn and unravel and discover if there's something called SIBO, which is small intestine bacterial overgrowth. And what that is, is really a condition where there's an overgrowth of bacteria in the small intestine. And when that happens, anytime that someone eats a carbohydrate that's going to be easily fermentable, let's say Brussels sprouts or let's say asparagus, which are good foods for us, right? They may just bloat up immediately, and they just feel like they're pregnant.

Dr. Drew Sinatra: So, I have lots of women come into my practice and they say, "Doc, I feel like normal in the morning. And as soon as I start eating foods, I just get bloated and bloated and bloated throughout the day. And by the end of the day, I look like I'm pregnant." And then they start telling me about, "Well, I'm suffering with anxiety. I've got major stress. I've developed this weird joint pain that came out of nowhere." And that's what I'm kind of thinking about, well, the gut is likely related to what's happening systemically in their body.

Dr. Steve Sinatra: So, the gut is not just about food, it's about stress. I mean stress affects the gut. What about alcohol?

Dr. Drew Sinatra: Yeah, the studies show, I mean, alcohol is really not great for the microbiome. I mean, you're certainly not going to feed the good guys by drinking alcohol. I think alcohol in moderation is not going to be a problem for most people for their microbiome. But you mentioned stress, and let's go into stress a little bit. And if we're eating our food, imagine the listener right now — you're at your table, and you've got a computer in front of you, you've got your TV in front of you, and you've got the news on — and you're just shoveling food in your mouth, right?

Dr. Drew Sinatra: You're not focusing on the food in front of you, you're not present and mindful with that food. You're thinking about what's happening in the rest of the world, which you really don't have any influence on anyway. And that's a major stress to be having when you're eating food — so that you're not in a parasympathetic rest and digest mode. You're in a sympathetic mode-

Dr. Steve Sinatra: Great point.

Dr. Drew Sinatra: ... And that's not going to support digestion.

Dr. Steve Sinatra: So, eating when you're nervous, eating under fear, eating under panic. Because a lot of us want to put something in our mouth, and basically it calms us down.

Dr. Drew Sinatra: And Dad, I love what you do is — when you and I eat a meal together, last night we had some grass fed beef, right? We had some mashed potatoes. What did we do before our meal? What'd you do really quickly?

Dr. Steve Sinatra: What did I do before?

Dr. Drew Sinatra: Yeah, what'd you say? You always do this.

Dr. Steve Sinatra: A prayer.

Dr. Drew Sinatra: You say a prayer!

Dr. Steve Sinatra: Oh yeah. That's right. I sort of bring more energy to the food, basically. In other words, I'm sort of energizing the food. I put my hands over it, and I'm trying to give the food a little bit of energy. And it's being sort of cognizant of the fact that the spiritual aspect of bringing our food and having food in the first place is very, very rewarding.

Dr. Drew Sinatra: Yeah. And it's bringing yourself in your body, in that moment, so that you can enjoy that food and not be stressed out.

Dr. Steve Sinatra: You make a good point. So when you say a little prayer, you're taking yourself out of fight-flight.

Dr. Drew Sinatra: Yes.

Dr. Steve Sinatra: And you're putting yourself in a calming mode. Now, I'm a big advocate, as a heart specialist, of digestive enzymes. And you're a naturopath and again, this is something in your specialty that I'm sure you do every day, but I take digestive enzymes after every meal. Do you recommend this to your patients, as well?

Dr. Drew Sinatra: Yeah, I recommend digestive enzymes to patients that are having digestive issues. But also for those that are aging too, because as you age, your digestive enzyme level is going to go down. The amount of enzymes that your pancreas and your stomach are going to put out is going to decrease. So anyone that is having bloating, abdominal issues, constipation, diarrhea, etc. — digestive enzymes can certainly help.

Dr. Steve Sinatra: Yeah, I mean for me personally, I mean, I take them after every meal. It's like brushing my teeth. I mean, I brush my teeth twice a day and I take digestive enzymes whenever I put anything into my mouth. And I'll tell you, Drew, I know it helps. I mean, I just know, I mean, I have less heartburn, less burping. I mean I even have, I feel like I have more energy. And from the cardiovascular point of view, I've always felt, and I've written this in my books — that digestion takes an enormous amount of work, and if digestion is requiring work, it's going to pull it away from the energy of the heart.

Dr. Steve Sinatra: And I have had so many patients in my practice, after eating a heavy meal, develop angina or a heart cramp. So my patients have been my best teachers, so to speak. If you can make it easier on digestion by taking in digestive enzymes, I mean to me, it's like money in the bank. I mean, I just do it. And again, my patients taught me that, because the angina was so frequent after a big meal without digestive enzymes, because we didn't know about it back then.

Dr. Drew Sinatra: Yeah, I mean that's the first thing to start off with is digestive enzymes. And also, let's teach our patients and tell them, "Well, hey, don't watch the news, right? Sit down, be thankful for your food and chew slowly, right?" If you chew your food thoroughly and slowly, you're going to secrete your body's own endogenous enzymes, which are going to really help facilitate that process of breaking down the foods.

Dr. Drew Sinatra: And of course, yes, if those who don't feel good after they eat a meal, they feel sluggish, they feel like they have brain fog, they're tired, digestive enzymes can definitely help. They're like, I think of them like a crutch. It's like you're healing, you're helping heal the organ that's just working too much.

Dr. Steve Sinatra: Right, and in an aging person like myself, I mean, I think it's a must. I mean, I just do it. Well, let me ask you this. I mean, there's a lot of foods out there that have a prebiotic support and a probiotic support. I mean, let's take sauerkraut, for example. I mean, I think sauerkraut's one of the greatest healing foods for the gut. I mean, what do you think about that?

Dr. Drew Sinatra: Well, sauerkraut, in many different ways, we're talking about cabbage. Cabbage has sulforaphane in it, right, which is going to help. It's like antioxidant, anticancer, etc., liver support. And in cabbage, and when you eat it in a sauerkraut form, which is fermented, there's going to be naturally occurring probiotics in there, and that's going to help, really, with digestive function.

Dr. Drew Sinatra: So anyone that really wants to provide a natural source of probiotics into their diet, consume sauerkraut, kimchi, miso, beet kvass, kefir, yogurt, all different sorts of foods have probiotics in them.

Dr. Steve Sinatra: And they also have some prebiotics, which-

Dr. Drew Sinatra: And prebiotics.

Dr. Steve Sinatra: So basically, what a listener needs to understand is that the prebiotic is food for the probiotic.

Dr. Drew Sinatra: Yes.

Dr. Steve Sinatra: So you're getting more mileage out of your probiotic by feeding them the food that they need, as well.

Dr. Drew Sinatra: Yeah. Thanks for mentioning that, because really it's not just about the probiotics, right? The probiotics are going to be, they're going to pass through if you take them in a... Let's say if you take a probiotic, they're going to pass through. They actually don't colonize.

Dr. Steve Sinatra: Right.

Dr. Drew Sinatra: Really, there might be some level of colonization that's happening, but really what they do is they exert their effects in a transient manner. So as they pass through, they're having their effect. Now, you need to support the growth and viability of these probiotics by giving them prebiotics. And in a food form, my favorite prebiotics are these really — garlic, right, onions, leeks, asparagus, dandelion. These are all forms of foods that are going to help feed the good healthy flora.

Dr. Steve Sinatra: Jerusalem artichoke too, that's a prebiotic.

Dr. Drew Sinatra: Yes, it's a huge one. Yep, exactly. Exactly. So you can't go wrong there.

Dr. Steve Sinatra: So in a final analysis then, should we all be taking probiotics, as a supplement? I mean, what do you think about that? I mean there's certain foods that we talked about that have prebiotic and probiotic value — but do we need a probiotic, the average person, the average 40-year-old person today? Do we need a probiotic?

Dr. Drew Sinatra: Yeah, that's really the million dollar question. I think early in my career I would have said no, because I think I tended to believe that we could get everything from our foods, right. And I was under the belief, too, that our environment wasn't as toxic as it was. But now, knowing what I know now, going to all these conferences and the naturopathic medical school I went to — we live in a toxic world. Okay?

Dr. Drew Sinatra: We live in a stress-induced world. We live in a world where the food supply is not as clean as we'd like it to be. And I mentioned that study about the antibiotics in the rivers. That's scary to me. We could be exposed on a low level to antibiotics through our water and through our food. So, knowing what I know now, I would recommend that everyone take a probiotic. And also at the same time, make sure you're eating fermented foods if you tolerate them okay.

Dr. Drew Sinatra: Because there are a subset of the population that might be histamine intolerant, where they have sauerkraut and they actually develop itchiness, or they develop brain fog, or they develop fatigue. And those people really need to work on healing their gut first before they start eating more fermented foods. But in general, most people can tolerate fermented foods. So I say eat those, which contain the pre and the probiotics. And then take a probiotic supplement, as well.

Dr. Steve Sinatra: As a heart specialist, one of the greatest risk factors is when you have a high triglyceride level and a low HDL. A lot of diabetics have this. For example, I always told my patients that if you had a triglyceride to HDL ratio less than two, that was suitable. If it's around one, that's ideal. Think about that, Drew, you have triglycerides of maybe 50 and an HDL of 50, it's one. Right?

Dr. Steve Sinatra: Then when we researched the literature and looked at some of these probiotic strains that lower triglycerides, I mean to me, this is the big deal. Triglycerides are a significant risk factor in coronary artery disease, and if we can lower triglycerides with certain strains of probiotics, I mean to me that's just putting money in the bank. So when I asked you the question, it was a rhetorical question. As a 40-year-old, knowing what I know now and after submitting that paper, from the cardiovascular point of view, I think all of us should be taking certain strains of probiotics.

Dr. Drew Sinatra: We should also get into probiotics in general, because the audience listening might be saying to themselves, well, geez, I go to the grocery store, I go to Whole Foods, and what do I see? I see a wall of probiotics there, and they're not all created equal. There's different strains out there. So there's different lactic acid forming bacteria, which is like more of the lactobacillus and bifidobacteria. A lot of people are familiar with those because they buy yogurt and they see that on the label.

Dr. Drew Sinatra: There's also yeast derived probiotics, like a Saccharomyces boulardii or Saccharomyces cerevisiae. And there's also the newer class of probiotics that we've been introduced to, and that's the soil-based organism probiotics, like Bacillus. Some people respond better to certain types of probiotics. Some people respond better to all three. So I'm kind of in favor of more of a combination product that has all three of them, because I think we're going to get more benefit by giving something like that then rather one at a time.

Dr. Drew Sinatra: But then again, some people they just, they didn't tend to do well just lactobacillus. So it's really person specific or patient specific, in that sense. And also a lot of probiotics that you'll see on the shelf, they may have been designed to contain a CFU or a colony forming unit. You might see anywhere from 200 million to 1 billion to 10 billion to 100 billion to even 500 billion organisms in there. And what really counts is that you find a formula that is guaranteed to have those organisms at the time of expiration.

Dr. Drew Sinatra: You don't want to have those organisms that are developed at a time of development, because they may not be in there the entire time. If you buy that supplement a year later, you're not guaranteed to have that 10 billion CFU count in there. But if you buy a formula that's guaranteed at the time of expiration, that 10 billion units, they will be in there.

Dr. Steve Sinatra: So somebody might, just to conclude here, a lot of us have children. I mean, you have young children. I mean, what do you do for your child's tummy? You know, you have a seven year old and a four year old, right?

Dr. Drew Sinatra: Yeah, yeah, yeah. Well, it starts off with teaching them how to eat fruits and vegetables from a young age.

Dr. Steve Sinatra: That's good.

Dr. Drew Sinatra: Because when you train them from a young age, it's a lot easier. I mean, when we have friends come over, they watch our kids eat and they're like, "I can't believe your kid’s eating Brussels sprouts. What is going on here?" And I say, "Well, we just started from a young age." Right, or whatever it is, asparagus or broccoli. I mean, our kids love greens. It's amazing. I feel blessed that they do.

Dr. Drew Sinatra: So it really begins with the foods, and starting them off at a young age. Now we, fortunately for my youngest son, he has not had to have antibiotics. My older son did have to take antibiotics for a tooth infection that he had. So when he was taking antibiotics, we definitely had him on probiotics at the time. And occasionally we do give them probiotics here and there, and we give them kimchi and sauerkraut, and we have miso some mornings for breakfast. And so we're always trying to get in the natural- fermented foods in as well, as a source of probiotics.

Dr. Steve Sinatra: So you're teaching your kids by example?

Dr. Drew Sinatra: Yes.

Dr. Steve Sinatra: And I'm going to wear my psychotherapist hat here. One of the things I know as a physician, as a psychotherapist — children will follow you do, not what you say. So if you're smoking cigarettes at home, and you tell your children don't smoke, but they see you smoking, guess what? They're going to pick up smoking, most likely. It's sort of an energetic transformation.

Dr. Steve Sinatra: So the fact that you're eating the way you eat — low sugars, you're taking in probiotics, prebiotics, fresh fruits and vegetables and things like that, your children are going to follow your lead, and they're going to do what mom and dad do. I think one of the greatest gifts we can give our children is following our lead because it's so simple. They'll follow what you do, not what you say.

Dr. Drew Sinatra: There's even research showing now that when you have family dinners, that is so important for the development of your child.

Dr. Steve Sinatra: Oh yeah.

Dr. Drew Sinatra: Having regular family dinners, and we really strive to have dinner every night with the kids. We don't offer a kid's menu. Okay, we don't just cook them macaroni and cheese, or offer them pizza. They eat what we're eating, because they should be. There shouldn't be this different diet between children and adults—

Dr. Steve Sinatra: But gluten-free varietals.

Dr. Drew Sinatra: Oh, our whole family is gluten-free, yeah, and sometimes we're dairy-free too, depending on the season. But what I can't stand is we go to a restaurant — let's say if we want to listen to some live music outdoors or something like that. We go there, and the first thing they do is hand our kids the children's menu, food menu. And I look at it and I'm like, this is all garbage. It's all junk. It's pizza, it's hot dogs, it's pasta. And so I say to them all the time, "No, we don't need that."

Dr. Steve Sinatra: Trans fats, yeah.

Dr. Drew Sinatra: They say to me, "What are your kids going to eat?" I'm like, "What, my kids are going to eat real food. That's what they're going to eat. They're going to eat what's on the adult menu, what we order." So, for our listeners, don't take the child's menu from the restaurant. Just have your children eat what's off the adult menu.

Dr. Steve Sinatra: Your plate, right, yeah.

Dr. Drew Sinatra: Yeah, your plate. Because like my father said, they're going to watch you, and if they see you eating good food, they're going to learn to eat good food too.

Dr. Steve Sinatra: Right, right. Habits begin in the house. So, Drew, this has been a great discussion about our gut health, and brain and heart health and everything. So, there's a lot of information we discussed. What are some takeaways that we, can we give our listeners? I mean the first takeaway that comes to my mind is, again, I suggest that our listeners take a probiotic-prebiotic supplement.

Dr. Steve Sinatra: I think given what we know in this day and age, I mean for me, it's like taking coenzyme Q10. I mean I take that every day, and I take a probiotic-prebiotic every day — and I eat foods with prebiotic value and probiotic value.

Dr. Drew Sinatra: And I want to just reiterate again the concept of going back to foods, right? And really eating a clean diet and making sure that you're removing any sort of food allergy or food sensitivity. So, work with an integrative doc out there to figure out if you do have that. We talked about the stress component — and I cannot stress that enough, really reducing stress in your life and making sure that you're in a peaceful, calm state when you're eating, because that's when digestion begins.

Dr. Drew Sinatra: And of course, if you benefit from digestive enzymes, you take a probiotic, those are all going to be good. And if you have something going on in your gut, let's say if you've got SIBO or you've got a candida overgrowth, that needs to be addressed.

Dr. Steve Sinatra: Right.

Dr. Drew Sinatra: Okay. And typically what we do is we give antimicrobials for that, or we might recommend an elemental diet, or a low FODMAP diet to really starve the bacteria there, so they don't grow in the small intestine. But if there is an underlying dysbiosis that's present, that definitely needs to be treated. And we didn't even talk about IBD at all. IBD is irritable bowel disease. It's a lot more serious than IBS, which is irritable bowel syndrome. And that's a whole other approach. We can probably have a podcast just on that alone.

Dr. Drew Sinatra: But people do need to understand that you need to work with a doctor sometimes around matters like this, especially if you have IBD. Okay? You don't just want to willy-nilly be taking really high doses of probiotics, because that actually could be harmful. If you have a level of leaky gut happening and you're taking a really high doses of probiotics, that's really not recommended.

Dr. Drew Sinatra: I was taught in school, I did a rotation on an HIV shift, and we were taught not to give probiotics to HIV people, because their immune systems were so compromised.

Dr. Steve Sinatra: Yeah, right, right, good point.

Dr. Drew Sinatra: I actually haven't delved into the research in a long time looking at that, but that is on my mind. In someone that is severely immune compromised, I probably won't put them on a probiotic to start off with. I really want to help heal their gut up. Or let's say if they have leaky gut, or if they have increased intestinal permeability. That's something that I really want to address first with them. Heal that up over a couple of months or six month long period or longer, and then bring on the probiotics. So, there's a time and a place for probiotics.

Dr. Steve Sinatra: So, I guess our final takeaway is that our gut health not only determines our joint health and our brain health, so to speak, and our heart health. But there's another factor in everyday life that I think we should enlighten our listeners about is that sometimes eating the "wrong foods" can create brain fog, as well. And we've heard about this even in our own family, with your brother for example.

Dr. Drew Sinatra: Yeah, exactly.

Dr. Steve Sinatra: And brain fog is on the rise right now. And I guess one of the pearls we can give our listeners is if you are also suffering from brain fog, think about what you ate that day.

Dr. Drew Sinatra: Thank you for bringing that up. That's huge. And a really quick tip for our listeners right now is — I talked about really being present at the dinner table, right, being present with your food. What I want you to do is notice how your body's feeling before you eat, and notice how your body is feeling after you eat. Do you feel anxious? Do you feel tired? Do you feel sluggish? Do you feel like your brain's not working?

Dr. Drew Sinatra: If that's the case, you've likely just eaten something that your body doesn't agree with. So you don't have to go out and get a fancy food allergy test, which in my opinion aren't even that great. Maybe you don't have to do a food elimination diet either, which can be challenging for people. Just be present with your food, know your body, and know the response that you get. And if it's not a good response, well, maybe the corn you ate, or the gluten you ate, or the dairy you just had is not agreeing with you. Simple as that.

Dr. Steve Sinatra: And my final words would be, folks, as Drew said, and this is a big term in bioenergetic analysis, is listen to the language of the body.

Dr. Drew Sinatra: Before we wrap up this episode of Be HEALTHistic, it's time to share our Wellness Wisdom for today. We've been talking about the importance of gut health, and how the wellness of our digestive system has a tremendous impact on our overall health — on our hearts, our brains, our skin, and our joints. Eating foods that are whole, natural and anti-inflammatory have been shown to promote better health and wellness throughout the various systems of the body.

Dr. Drew Sinatra: So in keeping with our discussion today, here are some things you can do to improve your gut health. Take probiotics and eat fermented foods, like fermented vegetables, kefir, kimchi, kombucha, miso, sauerkraut, tempeh, supplements with a prebiotic fiber, and eat fiber rich foods. Eat less sugar and sweeteners, which can cause gut dysbiosis or an imbalance of gut microbes. Reduce stress. Avoid taking antibiotics unnecessarily, as overuse is a significant public health concern that can lead to antibiotic resistance. Exercise regularly, get enough sleep, use non-toxic beauty and household cleaning products, and eat a mainly plant-based diet, choosing organic when possible.

Dr. Drew Sinatra: I'll also have a link available for a list of the “dirty dozen” foods you should avoid. Hopefully some of these tips will help you improve your microbiome for a healthier gut and better wellness overall.

Dr. Drew Sinatra: Remember everyone, if you liked what you heard today and you want to be an active member of the Be HEALTHistic community, subscribe to our podcast on Apple Podcasts or wherever you download your favorites. And subscribe to our YouTube channel. You can also find more great content and information from us and the Healthy Directions team at HealthyDirections.com, as well as on our social media channels. Check it out.

Dr. Drew Sinatra: I'm Dr. Drew Sinatra.

Dr. Steve Sinatra: And I'm Dr. Steve Sinatra.

Dr. Drew Sinatra: This is Be HEALTHistic.

Dr. Steve Sinatra: See you next time.

Narrator: Thanks for listening to Be HEALTHistic, powered by our friends at Healthy Directions, with Doctors Drew and Steve Sinatra. See you next time.