These days, it’s fashionable to pop antibiotics like Tic Tacs, and it’s almost impossible not to feel pressured into pumping sanitizer onto our hands when we enter or leave any store.
But did you know that even occasional use of antibiotics, hand sanitizers, and other germ-killers can wreak havoc on your long-term health?
Evidence is mounting that this germophobic clean craze – our obsession with antibiotics, hand sanitizer and sterile environments – is actually making us sicker.
Why? Because our bodies were perfectly designed to have a symbiotic relationship with bacteria, protozoa, fungi, and even viruses. When you wipe all of those “bugs” away, your immune system can turn on itself.
Hence the current epidemic of auto-immunity.
And if we stop to take a quick look at the chemical ingredients in some of these hand-sanitizer, you may notice things like Triclosan, which is an endocrine disruptor and toxic to microbes and can actually cause thyroid issues and a lot of other problems.
So in this special throwback episode that seems more timely than ever, we’re here with Dr. Robynne Chutkan, a leading expert in the world of gut health and one of the most recognizable gastroenterologists working in America.
Dr. Chutkan has a B.S. from Yale and an M.D. from Columbia, and is the best-selling author of multiple books, including ‘Gutbliss‘,’The Microbiome Solution‘ and ‘The Bloat Cure‘.
On today’s throwback with Dr. Chutkan you’re going to learn:
- The value of getting dirty
- Why you should reconsider using hand sanitizer
- How to rewild your microbiome
- And much more…
Let’s go hang out with Dr. Robynne Chutkan.
Dr. Robynne Chutkan: How To Achieve “Gut Bliss”
Abel: Alright folks, today we’re here with Dr. Robynne Chutkan, who’s one of the most recognizable gastroenterologists working in America today.
Dr. Chutkan has a BS from Yale and an MD from Columbia, smarty pants, and teaches in the gastroenterology department at Georgetown University Hospital.
An avid snowboarder, marathon runner, and Vinyasa Yoga practitioner, she is dedicated to helping her patients live not just longer but better lives by rewilding the microbiome.
How’s it going, doc?
It’s going great. I think I need to point out, I’m a slow marathoner, I haven’t hit my sub four yet.
Abel: Well, I don’t think anyone who runs marathons is a slouch, having run a few myself.
So, obviously you’re one of those crazy type A personalities who goes on a lot of adventures over the course of your life, and I really loved your book, because you’re so open about not only the things that you’ve discovered that you think can help people, but the things that you’ve done wrong along the way.
So, why don’t we start with one of the biggest mistakes that people make today, which is being germaphobes, and kind of buying into this “we are separate from nature” concept.
Give us just a general overview of what you do as it relates to rewilding.
So, there’s no question that this idea of cleanliness being equated with good health, we’ve really gone overboard with it.
And you walk into the hospital, everything is antiseptic, it’s super clean. There’s certainly situations where that’s helpful, if you’re doing abdominal surgery on someone it’s a good idea to keep the room clean.
But it’s permeated, it’s sort of trickled into regular everyday things.
So kids are scrubbed clean, there’s hand sanitizer everywhere. They’re not allowed to have dirt on them.
And what we’re finding is, not only is this not associated with good health, it’s associated with poor health. Because the microbes that are part of our skin, part of our gut, all over our bodies, are really an essential part of our ecosystem, and they help to keep us healthy.
So we’ve had this whole paradigm shift in medicine, from really figuring out how to eradicate germs and how to get rid of germs, to now realizing we need to figure out how to nurture them.We need to nurture our germs. Click To Tweet
Abel: Yeah, and one of the things that was so helpful to me when I kind of made that transition, in philosophy really, was not thinking of the body as something that’s separate from the environment, where you need to dominate all the germs around you, but really you’re nurturing an ecosystem when you’re eating or when you’re washing or when you’re doing anything.
Can you talk a little bit about that?
So, we’re host to this incredible population of about 100 trillion microbes, and while we think of those as mostly bacteria, there are also viruses, and fungi, and protozoa, little one-celled organisms, that are also super important.
And, so again, I think it’s helpful to think of ourselves as a host, the way we think of the Earth as a planet and we’re host to all the animals. Well, we’re a smaller host to all these microbes.
And if we’re good to them, they’ll be good to us, ultimately.
I love your point about this environment and sort of being one with nature.
I wasn’t much of an eco-biologist before I wrote this book, but if you look externally at what’s happening in our environment, with incredible species die off, the biggest one since the dinosaurs disappeared.
We’re losing species at a rate of about a thousand a year, much faster than what should occur naturally, the exact same thing is happening in our microbiome.We are experiencing a microbe extinction. Click To Tweet
If we look at gut bacteria, we have about two-thirds of the species that somebody in the Amazon who hasn’t been exposed to sort of western medicine and lifestyle and super-sanitization has.
So we’re seeing the exact same species die off, of these really important microbes in our body that we’re seeing externally in the environment with the animals disappearing, and the forests and the fish and everything else.
Why Is Our Microbiome Important?
Abel:But I thought all these creepy crawlies and parasites and things like that were bad for us, they sucked our life force. 🙂
The Center for Disease Control (CDC) gives a number of about one-third of Americans have been exposed to, or actually have a parasite, and our immediate reaction is sort of, “Ah, get me some antiparasitic drugs to get rid of them.”
So we’re only now beginning to realize that there is this incredible symbiosis between some of these organisms, including some kinds of parasites.
And most of them are still sort of pesky, but we’ve certainly evolved with them.
So there really is sort of two elements to this, the first is the current role of protozoa, bacteria, parasites, viruses, fungi, all of these things in our health, and the second is the development, the training of our immune system.
So it’s vitally important that we’re exposed to some of these organisms, the good, the bad, and the ugly, so that our immune system learns how to distinguish between friend and foe.
Learns to say, “Okay, this is just a sort of common-cold virus, no big deal. Woah, here comes polio, this is a really big deal, need to make lots of antibodies.”
And this distinction between friend and foe, this training, happens really early on. It happens shortly after birth.
And what we’re finding is that those of us who live in this super-sanitized Western environment, we miss out on that.
And so our immune systems get confused, and ultimately our immune system creates a situation where the body starts to react to itself.
And that’s basically autoimmune disease.
So whether it’s the joints reacting and joint destruction and arthritis, it’s the skin, things like psoriasis, it’s the gut, Crohn’s.
So again, there are germs that we need now, because they’re part of the ecosystem and they keep things balanced.
And so, for example, the balance between Staph and Propionibacterium acnes on the skin, and if that balance is disrupted, you can get acne, you can get eczema, but also the training of the immune system throughout our life really starting right after birth.
Why Getting Dirty Is Good For Your Gut
Abel: Yeah, and I think that’s so fascinating. One of the other things that really resonated with me as I read your book was your description of the way that you were raised compared to the world that your daughter was raised in, where we’re so trigger-happy against killing everything, it seems, right? But particularly with antibiotics.
So can you talk about what your father did when you tended to get sick as a child compared to what happens typically today?
So fortunately my dad is on a plane flying back from Hawaii and there’s no chance that he’s watching this. Otherwise he might be a little upset.
My dad’s an orthopedic surgeon, now retired at 80.
And I think there’s sort of two kinds of doctors; the kind who have drunk the Kool-Aid and really believe in sort of better living through chemicals and prescriptions, and the kind like my dad who sort of have one eyebrow raised and are, you know, judicious use of this stuff.
So my dad’s great fear, I think, for the three of us, the three kids growing up, was that we would be hypochondriacs.
He’s an orthopedic surgeon.
He saw a lot of people who were applying for disability, for back pain and these sorts of things that were difficult to really know what was going on for sure.
So his standard answer if you weren’t feeling well was, “Go and lie down and you’ll feel better in morning.”
And by the way nobody really wants to hear about it.
And I remember we were living in the Bahamas at the time, I remember I was running on the dock, a floating dock, barefoot, of course.
And a nail went up into my foot and I went into my parents’ room and I had this bloody foot, and he was like, “Yeah, just go lie down, you’ll feel better.”
And that’s pretty much what happened.
Fortunately I was up-to-date with Tetanus and I still have the foot.
But in all seriousness, it was a fairly hands-off approach.
I think we were not over-medicalized, we were appropriately medicalized. We had the appropriate shots.
Of course, back then, kids got measles and chickenpox and various things that they don’t get now, and that’s a whole separate conversation.
But there wasn’t this sort of running to the doctor every time we had a cough or a cold, and there wasn’t this check to make sure we were pristinely clean—quite the opposite.
And I do feel like some of my relatively good health is a result of the fact that we were left to run around and get dirty.I think some of my good health is because we were left to run around and get dirty as kids. Click To Tweet
We spent a lot of time at my grandfather’s farm, which is a sugarcane farm with lots of goats and cows.
And I recall vividly having pinworm from running in the sugarcane fields barefoot. And there are lots of animals around.
I’m not advocating pinworm as a way to get healthy, but it’s interesting that therapy, worm therapy, helminth therapy, primarily hookworm is something that has been found to have real promise for some autoimmune conditions, Crohn’s disease in particular.
And there’s a feeling that dampening down the immune system, which is what happens when your body has a chronic infestation, not a sort of life-threatening infestation, but it dampens down the immune system, sort of like how pregnancy dampens down the immune system so that your body doesn’t reject the growing fetus, which is helpful for autoimmune diseases.
So it’s really fascinating that something like pinworm and things like hookworm that we thought of as these terrible things are now re-emerging as potential therapies for autoimmune diseases.
Abel: Right, because when you look around, anyone who’s gone to visit a foreign country generally outside of the West or an indigenous culture, you look around at some of these people, they’re living very long, very happy lives.
They’re exposed to all sorts of crazy stuff.
But you bring in a random white dude like me, and we immediately get sick and we’re so weak, and it’s just a startling difference between the worlds that we really come from, what we’re exposed to.
So how can we get a little bit closer to having that effect of being—there’s a concept called antifragile, that’s the title of a book as well, where basically when you expose yourself to some amount of stress or sickness or something like that, there’s a threshold basically that allows you to get stronger and adapt.
So how can we get closer to where humans originally came from?
Yeah, it’s a whole sort of taking the cold shower in the morning, right?
Abel: Right, exactly.
Yeah, absolutely, shocking yourself a little bit.
So I think it’s super, super simple.
And having a dog, it’s really interesting to observe how our dog Hugo does things.
Hugo, is our new addition to our family.
It’s been fascinating. It’s not just been joyful, but really fascinating watching Hugo. Hugo does not wipe his feet on the front mat when left to his own devices.
Abel: He wipes it on the couch probably, right?
He wipes it on the couch or on my white dress or something.
But there’s not this obsession on his part, or on my part anymore, happily, for him to be clean all the time.
And, in fact, a lot of what he’s doing, when he’s sniffing around other dogs and he’s sniffing around their poo, and he’s rummaging around, is really important for his immune system.
It’s important for him to get a little bit dirty, too.
So if we look at how kids play, left to their own devices, they get sweaty and dirty, and really small kids they’ll even eat some of the dirt, quite frankly, in the sand box.
And we really sort of reel against that when we whip our hand sanitizer and we wipe them down.
And their natural instinct to play, to be on the ground, to be on their hands and knees, to maybe stick a finger in another kid’s mouth, or lick another kid—or in the case of my daughter when she was a little, bite a friend.
You know, you see how close that is really to the animal kingdom.
And at the end of the day, we’re animals.
At the end of the day, we’re animals. Click To Tweet
I’m not advocating that we get back to the cave and we get on all fours, but we have come so far, we have traveled really way too far from our roots.
And some of these behaviors, these sort of scrubbing everything away, aren’t just sort of net neutral, they’re downright harmful.
So I think really all you have to do is sort of go outside, look at toddlers playing, look at some dogs running around, to sort of start to get a sense of, ideally, how we can start to rewild ourselves.
How Hand Sanitizer Makes You Sick
Abel:What about hand sanitizer?
That’s something that some people just absolutely swear by. I have never really liked it, it felt strange to me.
And I love how you just rip on it in your book, can you talk about that a little?
So the problem with hand sanitizer is, if you are a user of hand sanitizer you have believed the false assumption that most diseases are caused by basic germs that you come into contact with in the environment.
And that’s just false. If you believe that, then you believe that eradicating all these germs is good.
And really, if you, for example, know somebody who never gets sick, or somebody who always gets sick, there’s really not a big difference typically between the germs that they’re exposed to. There’s a big difference with their immune system.
And so the idea is not to eradicate all these germs and to hide from the germs and to scrub them away.
The idea is to have a healthy immune system so that when your body encounters these germs, it’s able to fight them.
And again, most of the germs, if you will, that a kid is encountering at recess on the playground. There’s not Ebola on the playground.
There’s not life-threatening stuff. So the problem with the hand sanitizer is that a lot of them contain an ingredient called triclosan.
They contain lots of objectionable ingredients, but triclosan is particularly problematic.
It’s what’s called an endocrine disruptor, so it can cause thyroid problems, other problems, but it’s also really toxic to microbes.
Triclosan is in household cleaning products, in products from sanitizer to building materials.
And testing has found that the vast majority of Americans have detectable levels of triclosan in their bloodstream.
When we look at the microbiome and the threats to the microbiome, it’s definitely one of the big ones.
And again, when you just sort of do the cost-benefit analysis of your child eating a snack with some dirt on their fingers and a little bit of dirt getting into the mouth, versus triclosan getting into their mouth, which is what’s happening over and over and over again.
It’s a very, very clear pathway to sort of get rid of the hand sanitizer.
That doesn’t mean if you’re visiting with somebody sick or it’s flu season, you’re around a lot of sick folks, it’s absolutely a great idea to wash your hands with some soap and warm water—regular warm water, regular soap.
But this idea of ingesting all these chemicals is a really bad idea.
The Business Of Being Born
Abel: Yeah, and the amount of these chemicals that we’re exposed to today can be very problematic to the microbiome specifically, which we don’t necessarily understand that well, yet.
It seems like we were fighting it off for decades, right?
And now we’re kind of realizing that, “Oh, maybe we took that a little bit too far.”
Now we have to re-populate our bacteria and microbiome with the good guys, and even some of the bad guys that look bad but actually appear to be good.
So why don’t we talk about next the concept of feeding the ecosystem.
Because there are certain things you mentioned in your book, HMOs, the different kind of HMOs when mothers are nursing babies, that actually cannot be digested by the human body itself, but actually feeds bacteria.
Let’s talk about how we actually feed the bacteria in and on our bodies.
So the HMOs are really fascinating.
And again, speak to this idea of nature being so important, because there’re no HMOs in canned baby formula.
There are lots of HMOs in breast milk.
And we’re referring to Human Milk Oligosaccharides that are one of the main constituents in breast milk that the baby actually can’t digest.
Because they’re there to feed the baby’s bacteria, the Bifido species and so on.
So it’s just a great example of how beautifully thought out and sort of how just well-functioning, if you don’t interrupt it and mess it up, how supremely well all of this functions.
We thought for a long time that the fetus was sterile, but now there are more reports that the microbiome really starts to develop in utero.
That there are probably a couple microbial cells that get in.
And there was just an article where scientists show that there are actually some viruses present in newborns, and everybody’s sort of like, “Oh? How did they get there?”
And of course, everybody wants to get out the Lysol, because we think of viruses as bad.
But it will be really interesting to see—I mean, this is hot off the press just a couple weeks ago. It will be really interesting to see whether some of these viruses are actually protective, and we have to re-evaluate the viruses, too. I wouldn’t be surprised.
But the first and probably most crucial aspect of the development of our own microbiome comes with birth as we pass through the birth canal through the vaginal canal, and that’s when we swallow a mouthful of microbes and our microbiome begins.
And it’s no accident that the baby kind of turns posteriorly to face the mother’s rectum, typically as a baby comes out through the birth canal, because the rectum is where there are a lot of microbes available for swallowing.
So that simple act. And, you know, I went to a really great medical school, received excellent training. I never heard this before, until maybe about a decade ago, and I was fascinated.
I was like, “What? Passing through the vagina is like this super crucial thing?”
And when you think about it, that’s sort of why we don’t have a zipper across our abdomen. There’s a reason that there is a vaginal canal and an exit out into the world.
But Martin Blaser is a very eminent physician, he is Head of Infectious Diseases at NYU, and his wife Dr. Dominguez-Bello has done some amazing research.
One particular study, I think this is primarily in South and Central America, is looking at the rising rates of C-sections there, which seems to be as much a problem there as it is here.
And of course it’s a huge problem for the microbiome, because when you are born by a C-section, you don’t get the benefit of those important vaginal microbes.
So she recommends taking just a simple gauze pad, swabbing it in the vaginal juices and then wiping the baby down with it as a way to sort of populate the baby’s microbiome.
The thing I love about it is it’s so simple.
You could even take the baby and put the baby between the mother’s legs, sort of right there at the entrance to the vagina. But swabbing the baby down is such a great idea.
And instead, what do we do? We sanitize the baby.
If you go to most hospitals, they whip the baby out after a C-section. And they immediately start wiping the baby down, and wiping off what little microbes might be there.
So again, it’s this confusion, I think it really is confusion about what’s healthy and what modern medicine can provide, and really losing touch with nature and why we’ve evolved for things to happen that way.There is confusion about what’s healthy and what modern medicine can provide. Click To Tweet
When women tell me they’re having a scheduled C-section for some convenient reason—and a lot of the patients I see have autoimmune diseases—and I tell them that this is a really big mistake.
And I tell them the statistics of the significant increased risk for obesity, autoimmune disease, asthma, allergies. People look at me like I’m making this up.
Abel: And death even, right?
Yeah, they can’t believe it.
They’re like, “What?”
Because we think of a C-section as a modern medical thing. And we have this very positive association with it.
And certainly, in some cases, it can be. It can be life-saving for the baby or the mother.
But the fact that one in three births are now done via C-section in the U.S., and the majority of those are certainly not necessary because of medical reasons.
Abel: And pumped full of drugs. When you described having your daughter and kind of getting to the other end of the medical system that we live in today, can you just talk about that, emotionally, what you went through?
Well, I had my daughter 10 years ago. And as I like to say, I hadn’t had my awakening.
So I still thought like, “This is great. I’ve got all these monitors. If something goes wrong, they’ll definitely catch it.”
But I have to say, there was a moment where I had the intrauterine monitor threaded up. It goes up through the vagina to the uterus. I had the external monitor. I had at least one IV going. I had a catheter in my spine for the epidural.
I was obviously on my back, fairly immobilized, and I thought, “I’m healthy. I don’t really have any medical problems at this point. This seems like a lot.”
It did seem like a lot.
And I think when you’re part of the medical community, we’re sort of biased to think that everything we do is helpful.
Where if it’s all done for a good reason, it’s all well thought out, there’s a lot of evidence-based medicine behind it, so it is really a loss of faith to find out that that might not be the case.
So a lot of what’s being done is being done for convenience, it’s being done for commerce. That’s a big one.
On the part of the hospital, the pharmaceutical company, the individual physician, and it may actually really not be in the best interest of the patient.
And it really took me a long time. I was lucky to be trained by people who are amazing mentors, who I really think have the patient’s best interest at heart.
So I wholly believed that was just the case with everything we did. And it’s been a very slow, but steady progression and evolution to really evaluate, and it’s something I ask my patients to do.
I can’t tell you what’s the right thing for you to do. I can’t tell you whether you should take an antibiotic for the sinus infection, but I want to arm you with information.
And I want to tell you what your doctor who’s prescribed this antibiotic has probably not told you, which is that after 5 days about 1/3 of your bacteria, your gut bacteria, are going to be gone, and they may not all come back.
It may take years for them to come back.
And so that’s what you need to know.
So we have this one-sided medical education, and it’s all about how great the technology, and the procedures are, and the medication.
And I think the downside of things is really not given its full due.
And that’s the amazing thing about people like you, and this whole do-it-yourself movement in health is that we’re arming people with really important information.
And we’re not saying antibiotics are bad, or never have a C-section.
But we’re saying, “Here’s what you need to know about the C-section and the drugs you might be getting, and here are the short-term, the medium-term and quite frankly, the long-term effects on your health and your baby’s health that’s probably never been brought to your attention before.”
So it’s really an honor for me to be able to do that for people.
Abel: Yeah, I love it.
And I kinda liken it to, if you come in without information to the hospital, for example, or when something goes wrong, it’s like you’re going to the mechanic knowing nothing about your car. Except you’re the car.
So I think it goes downhill fast.
We talked before the interview about how some people shuffle their feet and slog along toward the more natural side of things. Why is there this resistance in coming over to the dark side as it were?
Well, I think that there is this great divide.
And I, again, was trained at very conventional places. I was at Columbia for medical school and residency. I was at Mount Sinai for my GI fellowship. I’ve been on the faculty of Georgetown since 1997. These are all terrific institutions, and I continue to hold them in high regard.
But part of the problem is when you say to a doctor, “The antibiotics that you’ve been prescribing are not just for the most part unnecessary, but they’re creating real disease. You’re swapping the common cold, which isn’t cured by an antibiotic anyway, and you’re creating Crohn’s, and eczema, and psoriasis, and MS.”
You feel like the villain.
As a physician a big part of our Hippocratic oath is “primum non nocere”—above all do no harm.
So now, we’re being presented with evidence from people who are saying that we’re villains, and what we’re doing is bad, and it’s evil.
And so it’s very difficult for physicians to acknowledge that what they’re doing, the very foundation of their medical education could be wrong, or it could be a little shaky in places.
It’s much easier for the average member of the public, the average lay person to say, “That makes sense. If what you’re telling me is that all these microbes, most of them play a really important role, and so if we remove them, now, things are out of balance. I can see how that could be a problem.”
Because they don’t really have a horse in the race. They weren’t raised with this indoctrination that these drugs are great and they’re life-saving. So they can accept it.
And it comes up over and over again, because the people who I have the hardest time convincing are my physician colleagues.
And I know this, because I was one of them.
I was one of them 10 years ago, or when patients would come in saying, “I’ve healed my colitis with diet by removing all the junk food in my diet and eating more plants.”
I would roll my eyes and go, “Really? How did you do that?”
I was completely skeptical, because the whole basis of my medical education was that you heal colitis with a drug that we prescribe.
And so it took lots of these patients to really open my eyes, and I’m so grateful to all of them and to see that there’s really a huge role for dietary lifestyle therapy.
Now, there’s also a role for the prescription therapy, because not everybody responds.
Most people do, but some people don’t. And part of the problem too is that we’re in this either/or situation, and I choose both.
I choose both.
Abel: Well, like you’re dad with the raised eyebrow, right?
Exactly. It’s not that prescription medications or procedures are bad, it’s that they’re overused and they should be applied more judiciously, I think is the basic problem.
Abel: Yeah, and I’ve become fiercely protective of my gut bacteria, in the sense that I haven’t taken antibiotics in years at this point.
It’s really interesting when you look at some of the studies, if people haven’t bought into the importance of the microbiome.
Check out some of these studies in mice where you can transplant microbes from one mouse to another and actually induce obesity or start to lose fat.
Other things like that have a direct effect over the way that your body actually works. Can you talk a little bit about that?
Absolutely. The mouse studies are really key.
So as you said, we’re able to create obesity in lean germ-free mice by transplanting microbes from obese mice and the mice gain weight without any change in the diet.
We’re able to predict obesity with about 97% accuracy just from looking at the microbiomes.We are able to predict obesity with about 97% accuracy just by looking at the microbiome. Click To Tweet
We are able to induce anxious behavior in normal mice by transplanting microbes from anxious mouse into normal mice. It’s really fascinating these mouse studies.
And of course, there may be more factors involved.
In humans, there’s often a genetic predisposition for disease. But what we’re finding is that the microbes are one of the important environmental triggers.
So identical twin studies give us really helpful information too. We see identical twins with the exact same genetic material, one twin might develop Crohn’s, the other one doesn’t.
Invariably, there are really big differences in the microbes.
So what we’re finding is that our microbiome really modifies our genes and is a big part of what determines whether we actually develop disease or not, including things like obesity and anxiety and depression, as well as diseases that we think of as more strictly genetic, like some forms of heart disease and autoimmune diseases.
So it’s really fascinating, this interplay.
And I can tell you we have a large international population in Washington DC, and I see a lot of people from all over the country at Georgetown.
And typically, I might be doing a screening colonoscopy in somebody who’s 60, for example. And if they’re born in the U.S., usually the list of medication is startling. They’re on an anti-depressant, plus an anti-anxiety medication, plus they’re taking aspirin prophylactically, plus they’re taking something for sleep, blood pressure, cholesterol, restless leg.
Typically, people are on 10-12 drugs.
And I look at their medical problem list and I see mostly lifestyle issues.
I see we have high cholesterol, we can fix that. Your blood pressure’s a little high, we can fix that.
I see all these things, mood disorders that can really be fixed quite simply most of the time through some lifestyle changes, and they’re on these pharmaceuticals.
And then I see people coming from Southeast Asia or parts of Eastern Europe. You see 80-year-olds that are on no drugs, and they look amazing.
And I think this common denominator is always that the people from these other countries that often we think of as less developed and inferior, have had limited access to the medical community, and I think that’s really sad.
And again, I don’t want to confuse things. Access to the medical community is great if you’re really sick.
If you’re sick and you have a disease and you need medical help, and we’re trying to increase access. But it has to be the right access.
It can’t just be access to more pharmaceuticals and more procedures. It has to, again, be this judicious access.
But when we see people or some of these people from the Blue Zones, people from all over. And bascially, they’ve done a lot of physical activity, usually not exercise, or usually not at SoulCycle necessarily, but they’re walking.
They’re walking four or five miles each way to the market, they’re gathering wood, they’re fetching water, and they’re eating a very basic diet, mostly plant based, mostly stuff that’s grown around them, if they’re not growing it themselves.
And it is just night and day.
Abel: Carrying dirt and microbes.
Yeah. It’s night and day in terms of health.
So again these are the things that we need to really pay close attention to.
How To Improve The Health Of Your Microbiome
Abel: Yeah. Now we’re coming up on time. But man, we could talk all day about this stuff.
Let’s talk about how you can actually nurture the good guys within your gut.
You talk about things like green banana flour, which I think is fascinating. You use it like mashed potatoes. What are other real world things that people can do and eat to make sure that they do have good gut health?
So the food is key.
And as I tell my patients, I can give you 900 billion bacteria a day, but if you’re not feeding them the right stuff, they’re not going to repopulate your colon.
The bacteria that you take in a probiotic have a very short life span. They don’t stick around very long.
And the idea is that they’ll stick around long enough to reproduce, quickly hit it to reproduce and start to repopulate.
But if you don’t feed them the right stuff, that’s not going to happen.
So what’s the right stuff? Indigestible or poorly digestible plant fiber.
So they flow on down to the colon where they get fermented by bacteria and they act as food for bacteria.
Foods that are high in inulin. So things like leeks and artichokes, asparagus, oats, those are all great.
Fermented foods are fantastic, sauerkraut, kimchi, any kind of fermented vegetables.
When you ferment a vegetable, when you take cabbage and you chop it up and you rub a little salt in it and put some water in it, cover it in a mason jar, what happens is that bacteria start to grow on it, Lactobacillus.
And so when you eat that cabbage later, not only are you getting the fiber from the cabbage that is going to feed your good bacteria, but you’re actually getting all this extra Lactobacillus bacteria that have grown in the fermentation process.
So that’s sort of the ultimate two for feeding your microbes.
Abel: Yeah. And then there’s the hottest trend these days—the stool transplant.
Can you talk about that a little bit?
Yeah. So FMT is the official name, Fecal Microbiota Transplant.
And once you get over the yuck factor, it makes perfect sense. If you think of a stool as a super probiotic.
So stool is somewhere around 70-80% bacteria, a lot of them dead. But that’s where the majority of the bugs are, the majority of bugs are in our gut and they come out in stool.
We still don’t know everything that’s in stool, so when we create a probiotic, we can sort of look at the stool and say, “Well, there’s Lactobacillus, and that’s helpful for this, and there’s Bifidobacteria, and that’s helpful for that, and there’s Streptococcus, and that’s good.”
And so we can take those strains and sort of amplify them and grow them and put them in a probiotic, but there’s a whole bunch of other stuff in stool that is as yet unidentified and we don’t know that we think is beneficial.
So when we transplant the stool, we’re transplanting the whole kit and caboodle, we’re transplanting all the potentially beneficial microbes.
The problem is we’re also potentially transplanting some harmful microbes and viruses.
So the testing, there are a couple of things about stool transplant. Number one, this isn’t the sort of thing to do because you think that you have an obese microbiome and you want to lose some weight, or you’re a little bloated.
You really need to be doing this because you have a serious, probably autoimmune illness, and there’s enough data out there, there are enough studies showing that this has been beneficial.
Because again, the risk of transplanting something that you don’t want to have is real.
And the other thing is, your transplant is only as good as the donor it’s coming from, so you don’t want to get stool from your boyfriend or girlfriend, husband, wife, mother, father, if they’ve been hanging out at the fast food restaurant every day and been taking a lot of antibiotics and sort of living that Western super-sanitized lifestyle.
So you want to make sure you’re getting some high-octane stool. I always say preferably foreign-born.
Abel: I was trying not to laugh, and then you said “high-octane stool.”
No, it really is because it’s all dependent on the quality of the stool.
And the other important thing, there’s been a lot of press about C. Diff, Clostridium difficile, which is a bacteria that can proliferate in our guts after we’ve been on antibiotics and lead to really serious infection in the colon, and even death.
And there’s an epidemic of C. Diff in the U.S. these days because of all the overuse of antibiotics.
So FMT, a stool transplant works great for C. Diff, which is sort of a one-time acute infection, and you give all these really healthy microbes, you crowd out the C. Diff, it goes away.
But for some of these diseases, for auto-immune diseases like Crohn’s and colitis, we’re looking at FMT for MS and some neurological things, this is an ongoing thing, because your microbiome isn’t just messed up that day because of C. Diff, your microbiome has sort of a long history of being out of balance.
And so what we’ve seen is that these patients really need to do it on a more regular basis, and that’s a real commitment to doing it.
What I’m thinking we’re going to be seeing in the relatively near future is the ability to take someone’s stool, take your own stool, analyze it, pull out the best microbes and then amplify them outside of your body, and then give you back your own stool, but better.
Abel: High-octane stool.
Yeah, it’s sort of your own higher-octane stool.
It makes perfect sense because then you don’t have the issue of, “Well, this person had some weird hepatitis virus that we can’t even test for, and now I have it.”
Abel: Yeah. Now, I did want to talk about this because my wife and I, especially over the course of the past few years, have become water snobs, and you talk about the dangers to your microbiome in consuming a lot of chlorinated water, other things in generally tap water that we find.
Why is that important? And why should people reconsider the water that they’re drinking?
Well, again, it all boils down to our microbes.
So there’s no question that sort of modern sanitation and so on has done a lot for us. We don’t have cholera outbreaks in major cities anymore, and things like that, but not only have they removed some of the healthy microbes that we get in natural sources of water, but they’ve also killed a lot of the microbes.
And the chlorine in the water and the chemicals continues to kill microbes when we ingest it.
So it is. The water’s super sanitized, too. I live in DC, I don’t want to go into Rock Creek Park and drink from the creek. That’s probably not a good idea.
Abel: I used to run there, don’t do that.
Yeah, maybe somewhere else, but not here.
So again, we’re kind of stuck between wanting to really live in a way that we feel is more in sync with nature, and healthier, but a lot of our options are sort of polluted and they’re not available.
More and more, there are options available, and one way to sort of fix the water thing is to get a chlorine filtration system for your house that removes most of the chlorine in the water.
Or two, if you have a place where you can get good natural spring water, that’s not been chlorinated, that’s helpful too.
But again, it’s something that people don’t think about.
And even if you have a chlorine filter for the water you’re drinking, you’re bathing, you’re ingesting a lot of water, all that chlorine is getting into your hair.
A lot of woman and men have hair thinning because of all the chlorine in the water. So it’s getting out to our skin, it’s disrupting our microbiome there.
So these are all really challenging things that we have to figure out: How can we live a little closer to the ground?
Abel: Right, yeah, if it’s turning your hair green, it’s probably not doing very good things inside of your body either.
And just getting one of those water filters for your tap or even your shower is one of the biggest bang for your buck things you can do to improve your health.
Now we feel if we go to someone else’s house or we’re traveling or whatever, and we don’t have access to really good water that’s pure, we can feel it.
It only takes a few hours. You go, “Agh, I feel lethargic. My stomach’s a little upset.”
Your body when it’s treated really well starts to be very conscious of the things that you’re putting in it.
So I think that’s such a great point that you raise in your book.
Now, before we go, please tell people a little bit about your book, where they can find you, and what you’re working on.
Where To Find Dr.Robynne Chutkan
So the book is called The Microbiome Solution: A Radical New Way to Heal Your Body from the Inside Out.
It was a much better hair day when the book photo was taken
Abel: Oh come on, you look great.
But that is me on the cover. And really, I wrote this book because I felt I had to write this book.
I was just seeing patient after patient who’d been on all these antibiotics, having these problems. It’s a very hands-on practical approach.
It’s sort of divided into three sections. The first is all about the microbiome, what it is, what it does. The second is how we mess it up, and the third is how to fix it.
It’s called the Live Dirty, Eat Clean Plan.
Abel: I love that.
So some very basic things, like opening a window, and getting a dog, to a list of what are the 10 most important questions you need to ask your doctor if you’ve been prescribed an antibiotic.
And what are the 10 most important things you need to do if you end up on an antibiotic anyway.
So there’s some really practical advice there.
We’re also hosting a series of patient education events, it’s called The Microbiome Solution workshop. The first one is January 30th in Washington, DC.
We have an amazing faculty from all over the country, and we’re really going to be giving people the specific tools to rewild themselves as well as to analyze their microbiome.
We’re going to be talking about testing that you do to determine whether there’s been damage to your microbiome, medications to avoid.
So it’s a great opportunity, if you’re somebody who is suffering from a disrupted microbiome, what we call dysbiosis.
It’s a wonderful all-day hands-on workshop, and we hope you can join us.
Abel: Awesome. Well, we need more great doctors with one eyebrow raised, so thank you so much for fighting the good fight, and I really appreciate you coming on the show.
Thank you so much for having me. This has been a ton of fun.
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