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Episode 22
The Doctor's Farmacy: House Call

Fixing The Root Causes Of Irritable Bowel Syndrome with Dr. Todd LePine

Open the Podcasts app and search for The Doctor’s Farmacy. If you’re viewing this site on your phone, you can just tap on the

Tap the subscribe button and new shows will be added to your library.

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Millions of people suffer from irritable bowel syndrome (IBS). These people struggle with miserable, often disabling symptoms like bloating, cramps, diarrhea, constipation, and pain. IBS can be caused by a range of factors, including food allergies, overgrowth of bacteria in the small intestine (SIBO), a lack of digestive enzymes, parasites living in the gut, zinc or magnesium deficiency, and heavy metal toxicity. That’s why it is so critically important to personalize treatment based on the unique circumstances that exist for each person who suffers from IBS.

In this episode, Dr. Hyman sits down with Dr. Todd LePine to discuss the numerous underlying issues that can contribute to IBS, what type of testing they conduct when working with patients experiencing IBS, and much more.

Dr. LePine graduated from Dartmouth Medical School and is Board Certified in Internal Medicine, specializing in Integrative Functional Medicine. He is an Institute for Functional Medicine Certified Practitioner. Prior to joining The UltraWellness Center, he worked as a physician at Canyon Ranch in Lenox, MA, for 10 years. Dr. LePine’s focus at The UltraWellness Center is to help his patients achieve optimal health and vitality by restoring the natural balance to both the mind and the body. His areas of interest include optimal aging, bio-detoxification, functional gastrointestinal health, systemic inflammation, autoimmune disorders and the neurobiology of mood and cognitive disorders. Dr. LePine teaches around the world, and has given lectures to doctors and patients at American College for Advancement in Medicine (ACAM), Age Management Medicine Group (AMMG), the University of Miami Integrative Medicine Conference, The Kripalu Center in Lenox, MA, and is on the faculty for American Academy of Anti-Aging Medicine (A4M). Dr. LePine is the head of the Scientific Advisory Board for Designs for Health and a consultant for Diagnostic Solutions Laboratory. He enjoys skiing, kayaking, hiking, camping and golfing in the beautiful Berkshires, and is a fitness enthusiast.

This episode is sponsored by AirDoctor. We need clean air not only to live but to create vibrant health and protect ourselves and loved ones from toxin exposure and disease. That’s why we’ve teamed up with AirDoctor to offer you the AirDoctor Professional Air Purifier systems at a special price. Learn more at

In this episode, Dr. Hyman and Dr. LePine discuss:

  • The conventional medicine approach to treating IBS
  • Stress and IBS
  • How the gut and the brain are connected
  • Why an IBS diagnosis tells you nothing about the cause of IBS
  • How having a history of colic as a baby, having been vaginally birthed or breastfed, your childhood diet, past antibiotic use, family history of digestive issues, and other information can provide insight into identifying the cause of and treating IBS
  • Small Intestinal Bacterial Overgrowth (SIBO), having a “food baby,” and auto-brewery symptom
  • Types of testing to diagnose IBS, including GI map testing, hydrogen methane breath testing, gastric level testing, IBSSure testing, and organic urine testing
  • The negative effect of long-term use of acid blockers
  • Reasons for IBS including food sensitivities, allergies, parasites, enzyme deficiencies, heavy metals, Lyme disease, autoimmune issues, akkermansia levels, and more
  • How eating a colorful diversity of vegetables and fruits benefits gut health and the microbiome
  • The relationship between the immune system and gut health
  • Common inflammatory foods
  • Stimulation of the vagus nerve for “resting and digesting”
  • Treating leaky gut with prebiotics, probiotics, diet, and nutrients

For more information visit

I hope you enjoyed this conversation as much as I did. Wishing you health and happiness,
Mark Hyman, MD
Mark Hyman, MD


Mark Hyman, MD

Mark Hyman, MD is the Founder and Director of The UltraWellness Center, the Head of Strategy and Innovation of Cleveland Clinic's Center for Functional Medicine, and a 13-time New York Times Bestselling author.

If you are looking for personalized medical support, we highly recommend contacting Dr. Hyman’s UltraWellness Center in Lenox, Massachusetts today.

Dr. Todd LePine

Dr. LePine graduated from Dartmouth Medical School and is Board Certified in Internal Medicine, specializing in Integrative Functional Medicine, and has advanced clinical training through the Institute for Functional Medicine. He has been practicing Functional Medicine for over 15 years focusing on Optimal Aging, Bio-Detoxification, Gastrointestinal Health, Systemic Inflammation, Autoimmune disorders and the Neurobiology of mood and cognitive disorders.

Show Notes

  1. The Wrong Gut Bugs Can Make You Fat and Sick (and How to Fix Them)
  2. Getting to the Root: Tackling SIBO with Functional Medicine
  3. 10 Strategies to Eliminate IBS and Create Good Gut Health
  4. 5 Simple Steps to Cure IBS Without Drugs
  5. How To Feed Your Gut
  6. Do Probiotics Really Work?

Transcript Note: Please forgive any typos or errors in the following transcript. It was generated by a third party and has not been subsequently reviewed by our team.

Dr. Todd LePine (00:00):
There’s really listening to the patient. And antibiotic use, did they have a lot of ear infections, did they have a lot of strep throat, did they get a lot of antibiotics? What’s going on in the family? Did anybody else in the family have any digestive issues? So just taking the time to get that history allows you to sort of play detective and try to figure out, “Okay, what are the things that are potentially playing a role in driving this, what kind of triggered it?” And then personalizing diagnostics, and treatment, and everything else.

Dr. Mark Hyman (00:31):
Welcome to The Doctor’s Farmacy. I am Dr. Mark Hyman, and that’s Farmacy with an F. F-A-R-M-A-C-Y, a place for conversations that matter. And if you’ve ever suffered from digestive problems, from irritable bowel syndrome, bloating and discomfort, you better listen to this podcast carefully because it is a special podcast of The Doctor’s Farmacy, which I call the house call series. And I’m sitting down with my colleagues from the UltraWellness Center in Lenox, Massachusetts.

Dr. Mark Hyman (00:56):
And today I’m joined by Dr. Todd LePine to discuss how we as functional medicine doctors tackle specific conditions we see at our practice every single day. And I am going to focus today on irritable bowel because that is affecting so many people. It’s the number one reason people actually go to the doctor, is digestive complaints. It’s a big problem, and it causes disability, and dysfunction, and misery for so many people, and it’s fixable. So Todd is a great friend and colleague. We’ve worked together for … pushing on almost 30 years, now.

Dr. Todd LePine (01:27):
A long time.

Dr. Mark Hyman (01:29):
And we’re still standing. He’s an extraordinary physician. A leader and thinker in the field of functional medicine. He graduated from Dartmouth Medical School. He’s board certified in functional medicine. And he worked with me at Canyon Ranch for many years. He teaches all over the world in various faculties, and is just a brilliant functional medicine physician. And I’m honored to have him as part of our center here at the UltraWellness Center. So, Todd, welcome to The Doctor’s Farmacy again.

Dr. Todd LePine (01:52):
Thanks, Mark. It’s great to be here.

Dr. Mark Hyman (01:54):
Okay, so let’s talk about this thing called irritable bowel syndrome. What did we learn about it in medical school?

Dr. Todd LePine (01:59):
Not much. I mean, I think we basically learned that it was one of those conditions where you sort of treat the patient, and it’s not serious, you’re not going to die from it. And I can remember, actually up at Dartmouth, we had [Dr. Almy 00:02:14], and he was an expert in irritable bowel. And back then, it was felt to be more of a sort of neurologic, sort of stress-related thing.

Dr. Mark Hyman (02:24):
A psychoemotional problem.

Dr. Todd LePine (02:26):
Psychoemotional. And this is an interesting side story. He did a test where he took some medical students and was measuring the manometry of them. And while he was doing the sigmoidoscopy, he was measuring the tension in the colon. And you could only do this to medical students, and this was back in the ’50s. And he told them, he goes, “I think I see cancer.” All of a sudden, there was a spasm of the colon.

Dr. Mark Hyman (02:52):

Dr. Todd LePine (02:53):
Yeah. And it was like he wanted to evoke to see what it was that was going on with the irritable bowel. And they thought it was a lot of those were nervous-related, which there is a stress component. And so back then, a concept of irritable bowel was that it’s all sort of in your head.

Dr. Mark Hyman (03:07):
We had a very fancy word for it in medical school. We called it supratentorial, which is a doctor’s way of saying it’s all in your head.

Dr. Todd LePine (03:14):
It’s all in your head.

Dr. Mark Hyman (03:15):
The tentorium is that thing that kind of separates your top of your brain from the lower brain. And it was a joke, but it was very pejorative. And we often thought that these patients were malingerers. It was called functional bowel disease.

Dr. Todd LePine (03:28):
Yeah. Yeah, you get a lot of terms.

Dr. Mark Hyman (03:30):
There was no real cause for it. It was more psychological and maybe stress-related, and these people are all emotional and upset. It turns out it’s not so, right? And we call it syndrome, right?

Dr. Todd LePine (03:40):
Syndrome, yeah.

Dr. Mark Hyman (03:41):
So when we say syndrome in medicine, what do we mean?

Dr. Todd LePine (03:43):
It’s a constellation of various symptoms. And we now-

Dr. Mark Hyman (03:47):
That we don’t know what the hell’s going on.

Dr. Todd LePine (03:48):
We don’t know. It’s like chronic fatigue syndrome. It’s like how many different things can cause chronic fatigue? It’s like there’s 23 flavors, or however many flavors of Baskin-Robbins ice cream. The same thing with irritable bowel.

Dr. Mark Hyman (03:59):

Dr. Todd LePine (04:00):
Yeah, 31.

Dr. Mark Hyman (04:00):
I used to scoop Baskin-Robbins ice cream. That was one of my jobs.

Dr. Todd LePine (04:03):
Right, right. And then that’ll probably cause irritable bowel.

Dr. Mark Hyman (04:06):

Dr. Todd LePine (04:07):
With all those artificial flavorings and sugar. So yeah. And nowadays, we sort of classify irritable bowel into irritable bowel with constipation, irritable bowel with diarrhea, and then mixed irritable bowel. That’s how we’re sort of putting an ICD-10 code on it. And that’s a way of conceptualizing it, but there are lots of different things that can play a role.

Dr. Todd LePine (04:29):
Without question, I think stress does play a role with irritable bowel, and I think that stress can manifest in the body in so many different ways. And we’ve talked about this when we’ve talked about autoimmune conditions. Because oftentimes when we have a patient, and some stressful event happens, it triggers a host of things. And it’s sort of like a ripple effect that goes on in the body. And without question, there is a stress component to some irritable bowel conditions.

Dr. Mark Hyman (04:54):
Well, yeah. I mean, you’ve got your second brain in your gut.

Dr. Todd LePine (04:56):

Dr. Mark Hyman (04:56):
There’s more serotonin in your gut than in your brain. You’ve got this whole nervous system that connects the two, that is extraordinarily complex and feeds back both ways, so from the top down and bottom up. So irritable bowel can cause irritable brain, and irritable brain can cause irritable bowel. It goes back and forth.

Dr. Todd LePine (05:10):
Right. And you want to have a happy bowel, a happy brain. That’s really-

Dr. Mark Hyman (05:13):
Sounds like the key to a happy life.

Dr. Todd LePine (05:15):
Happy bowels, happy brain. Exactly, exactly. Yeah, it’s an interesting thing that you talk about, because you have that gut/brain connection, and it’s like a two-way highway, and they’re basically communicating. The brain’s talking to the gut, and the gut’s talking to the brain. And then you also have the enteric nervous system, and some people sort of forget about the enteric nervous system. And that’s the intrinsic nervous system to the gut, so literally if you sever the spinal column, and there is no connection to the gut in the brain, the gut still works. You can still poop fine if you sever the spinal column.

Dr. Mark Hyman (05:49):
It’s got a mind of its own, is what you’re saying.

Dr. Todd LePine (05:52):
It’s got a mind of its own, exactly. Right.

Dr. Mark Hyman (05:54):
But, Todd, I want to come back to what you said, which was really important. You said we categorize irritable bowel as with constipation, or diarrhea, or whatever. And there’s a whole classification system that is driven off of symptoms. And the difference between functional medicine and conventional medicine, thinking about any disease, is that it’s not focused on the symptoms. It’s focused on the causes. So just saying people have irritable bowel doesn’t tell you anything about the cause. It tells you they feel uncomfortable, they’re bloated, they have diarrhea, their bowels are weird. They’re uncomfortable, cramping, whatever the symptoms are. It’s irrelevant when it comes to trying to figure out the cause.

Dr. Mark Hyman (06:30):
I mean, “Yeah, okay, you have irritable bowel.” But when you start to think about the problem, in traditional medicine, you name the disease, you stop thinking. And our colleague, [Sid Baker 00:06:40], always had this great term. He says, “Traditional medicine is naming and blaming.” You name the disease, and then you blame the name for the problem. “Oh, I know why your stomach hurts. You have irritable bowel syndrome.” No, that’s just the name of darn problem.

Dr. Mark Hyman (06:53):
But he talked about thinking and linking, which is functional medicine, right? You think about the problem and the cause, once you get the diagnosis, and you link everything together to see what the factors are. And there’s no such thing as irritable bowel syndrome. There’s irritable bowel syndromes. Like you said, there’s 31 flavors, and each one is different, and each one needs to be treated differently.

Dr. Todd LePine (07:13):
Exactly. Exactly. Yeah, it’s so, so, so true. And there is this web-like interaction in the body, and it’s very important to understand the whole interconnectedness of it. It’s very, very important.

Dr. Mark Hyman (07:26):
So typically you go to the doctor, and you have irritable bowel. What do they tell you to do?

Dr. Todd LePine (07:32):
Well, they’ll often tell you, “Take some Metamucil, and I’ll see you later.”

Dr. Mark Hyman (07:38):
Yeah, eat more fiber, drink more water, and learn to live with it, and deal with stress.

Dr. Todd LePine (07:40):
Yeah, that’s essentially what they’re doing. Yeah, deal with stress. And the interesting thing, I had a patient just the other day who I was seeing for GI symptoms. It wasn’t specifically irritable bowel. And the patient’s GI doctor said, “Diet has nothing to do with your symptoms.” I mean, it was unbelievable that a GI doctor told her, “Diet makes no difference.” I couldn’t believe it.

Dr. Mark Hyman (08:10):
Actually, I was on a consult with a patient yesterday, and she said, “I went to my gastroenterologist, and I wanted to show him my stool test. He says, ‘Oh, gastroenterologists don’t look at stool.'” I’m like, “Well then, who does, if you’re a doctor?” And I’m like, “That just doesn’t make sense. You don’t look at what goes in, and you don’t look at what comes out. How are you supposed to know what’s going on in there,” right? And that’s the difference in functional medicine.

Dr. Todd LePine (08:38):
Yeah, exactly. Yeah, it’s a little bit mind-blowing. And yeah, you talk about … Going back to Sid Baker and sort of the name it and claim it kind of a thing-

Dr. Mark Hyman (08:47):
Blame it.

Dr. Todd LePine (08:47):
Yeah, name it and blame it, is that-

Dr. Mark Hyman (08:49):
And then tame it with a drug.

Dr. Todd LePine (08:50):
Right. And then I always tell my patients I went from being a medical student to a student of medicine. I like to always learn about things.

Dr. Mark Hyman (08:57):
Oh, I love that.

Dr. Todd LePine (08:58):
Yeah. And it’s a very important thing that you have to remain open-minded, and I think you also have to remain curious, because every patient’s different. That’s actually the joy of actually practicing functional medicine, is it’s not boring by any means. You’re constantly growing, and learning, and helping patients with the latest diagnostics or the latest therapeutics to personalize their treatment. And that’s the fun part.

Dr. Todd LePine (09:23):
I mean, doing functional medicine is a wonderful profession, as opposed to regular mainstream medicine where most doctors are burned out. They really are. They’re just unhappy. They’re burned out. They’re doing the rubber stamp medicine. “I’ll see you. Here’s your proton pump inhibitor. Next patient.” That’s it.

Dr. Mark Hyman (09:41):
Yeah, right. So the doctor sees you, you have irritable bowel, they give you Metamucil. What else can they do, sometimes?

Dr. Todd LePine (09:48):
Well, sometimes they’ll give prescription medications. I think one of the older ones that they used to do for IBS was Zelnorm. Remember that one?

Dr. Mark Hyman (09:55):

Dr. Todd LePine (09:55):
They took it off the market because it was really hurting people. I think people were getting-

Dr. Mark Hyman (09:59):
Librium was the other one. Remember that?

Dr. Todd LePine (10:01):
Librium, yeah.

Dr. Mark Hyman (10:01):
That was like a Valium. It was basically like taking Valium.

Dr. Todd LePine (10:03):
It was Valium for the gut, yeah. And in certain patients, there were some benefits from that, because it did sort of calm down the nervous system, I think.

Dr. Mark Hyman (10:14):
Sure, anybody taking Valium-

Dr. Todd LePine (10:16):
Yeah, you’re going to feel good.

Dr. Mark Hyman (10:18):
A couple shots of tequila, a little Librium.

Dr. Todd LePine (10:19):
“I feel good.” Yeah, right.

Dr. Mark Hyman (10:23):
But that’s really not what we do in functional medicine.

Dr. Todd LePine (10:25):

Dr. Mark Hyman (10:25):
You were talking before about how you never know what the issue is when someone comes in. I was thinking about it. It’s much like Forrest Gump medicine. Forrest Gump has a box of chocolates. He says, “Life is like a box of chocolates. You never know which one you’re going to get.” And I think in traditional medicine, you’ve got irritable bowel, it’s a thing, you treat it all the same.

Dr. Mark Hyman (10:41):
Functional medicine is not like that. We see somebody with irritable bowel, and then we go, “Wait a minute, what is the cause of their irritable bowel?” And like you were saying before, it’s very personalized. So how do we start to think about identifying what their particular issues are? Because before with can even treat it, we have to understand the why. And that is what I always say, functional medicine is the medicine of why, and regular medicine is the medicine of what, what disease and what drug.

Dr. Todd LePine (11:04):
And I think the big thing is time, taking the time to talk to a patient.

Dr. Mark Hyman (11:09):
What? Talk to a patient?

Dr. Todd LePine (11:11):
Actually, and listen to the patient.

Dr. Mark Hyman (11:12):
Wow, listen to the patient?

Dr. Todd LePine (11:15):
Actually, sometimes the less I talk during an interview, an evaluation of a patient, the better I do. Because oftentimes we want to jump in and ask this question. They’ll say something, and we ask a question. I think in the average doctor’s office, a patient speaks for 30 seconds, then the doctor interrupts them.

Dr. Mark Hyman (11:33):
Yeah. No, actually, there was a study published, years ago in JAMA, it was 18 seconds-

Dr. Todd LePine (11:38):
18 seconds or 20 seconds.

Dr. Mark Hyman (11:38):
-before the doctor interrupts.

Dr. Todd LePine (11:40):
Exactly, because we’re trained to probe the questions, and they have their own sort of path of thinking, going down that. But I think the big thing is we spend a lot of time listening to the patients and getting a history, a story. And an important thing, an interesting thing in terms of IBS patients, is that babies who have colic … And they’ve actually looked at what is it that causes colic in babies. And the latest evidence is that babies that have colic have high levels of Klebsiella. Klebsiella is a bacteria.

Dr. Todd LePine (12:13):
And we know that Klebsiella is actually associated with other inflammatory conditions and autoimmune conditions. So Klebsiella excess in the gut is actually associated with ankylosing spondylitis, which is an inflammatory bowel disease which manifests systemically with arthritic symptoms. So getting a history of colic is important. Listening to the history of were they vaginally birthed, were they breast-fed, what type of diet did they have as a kid-

Dr. Mark Hyman (12:41):
Yeah, when did they get food introduced.

Dr. Todd LePine (12:43):
Yeah. And all those things can play a role in terms of-

Dr. Mark Hyman (12:45):
Like early gluten, for example, or early dairy can trigger a leaky gut.

Dr. Todd LePine (12:49):
Exactly. And there’s really listening to the patient. And antibiotic use, did they have a lot of ear infections, did they have a lot of strep throat, did they get a lot of antibiotics? What’s going on in the family? Did anybody else in the family have any digestive issues? So just taking the time to get that history allows you to sort of play detective and try to figure out, “Okay, what are the things that are potentially playing a role in driving this? What kind of triggered it?” And then personalizing diagnostics, and treatment, and everything else. It’s all about personalization.

Dr. Mark Hyman (13:20):
I think it’s very, very different, what you’re saying. This approach really is being a medical detective.

Dr. Todd LePine (13:24):

Dr. Mark Hyman (13:24):
And it is relevant whether you were breast-fed, or for example, or vaginally birthed, because that affects your gut flora and the development for your whole life. I mean, I recently read a study that showed bottle-fed babies have high levels of what we call a short-chain fat, which is made by the good bacteria. This one’s called propionic acid. Now, this is not such a good one, and it’s been shown to induce autism in animal studies, and has been associated with autism and ADD. That is increased when you’re bottle feeding.

Dr. Mark Hyman (13:53):
When you breast feed, you get an increase in butyrate, which is the beneficial short-chain fat that actually heals the gut, and it reduces inflammation, and does all sorts of good things. So we think, “Oh, what’s the difference, bottle-fed, breast-fed?” That’s not to make people feel guilty if they have to bottle feed. You have to do it, sometimes. But you can fix that by making sure they have the right prebiotics and the right probiotics. Because breast milk has undigestible fibers that are prebiotics and sugars that are prebiotics for the good bugs, that aren’t actually digested by humans. Breast milk knows that.

Dr. Todd LePine (14:22):
Exactly. And the other interesting thing about breast milk, I mean, if we could sort of bottle breast milk, it’s very, very powerful stuff. There’s a thing in breast milk called milk oligosaccharides, and these are very, very complex sugar moieties, sugar chemicals. And they’re actually so complex that, for a long time, science didn’t even study them because they were too complex. It was like a Lego set that was this incredible building blocks.

Dr. Todd LePine (14:47):
And what they’ve done now, and there are a couple of companies … One company in specific, out of Europe, is actually synthesizing one of the oligosaccharides in milk. And there are actually hundreds of them, and these act like fertilizer for the good bacteria. So these things that are found in breast milk are very, very powerful things. Yeah.

Dr. Mark Hyman (15:07):
Yeah. So powerful. And so we dig down into the story and figure out when did it start, and what’s connected to it, did you have foreign travel. Because people often have post-infectious irritable bowel syndrome, people can get it after antibiotics, people can get it after any kind of stress or trauma. And people don’t realize that it’s connected to so many different things. So let’s talk about what are the causes, and then we’ll go into sort of a case of how we would deal with this. So what are the top causes that you have found in functional medicine, that are driving irritable bowel syndrome for people?

Dr. Todd LePine (15:38):
Well, a lot of irritable bowel also is probably misdiagnosed, I think, as SIBO. And SIBO is this diagnosis of small-intestinal bacterial overgrowth.

Dr. Mark Hyman (15:49):
So a bunch of people with irritable bowel have SIBO-

Dr. Todd LePine (15:51):

Dr. Mark Hyman (15:52):
-or bad bugs growing where they shouldn’t be in the small intestine?

Dr. Todd LePine (15:54):
Exactly, yeah. And I think that we’re sort of finding that a lot of these people that we’re diagnosing with this catch-all term, they’re really having potentially small-intestinal bacterial overgrowth. There are tests that you can do for that. We do the-

Dr. Mark Hyman (16:07):
That’s also known as a food baby. When you eat food, and you get a big, bloated tummy right after, and that’s a food baby, that’s what SIBO is.

Dr. Todd LePine (16:15):
Right. Because what’s happening is we have bacteria on our skin, we have bacteria in our mouth, we have bacteria in our stomach, the small intestine, and the large intestine. Most of them sort of live in the colon, but there are times when the colonic bacteria is sort of migrating upwards, and they go higher up. And it’s sort of like invading a neighborhood.

Dr. Mark Hyman (16:35):
Yeah, because it’s mostly sterile up there.

Dr. Todd LePine (16:38):
Yeah, not necessarily. We always thought it was sterile, but even the stomach has bacteria in it. But it’s just much less, and there are all different kinds of bacteria. So the lower bacteria are more fermenters. They ferment things. And that’s where we get … I think I have talked about that, and I’ve seen this a couple of times, the auto-brewery syndrome, where patients … In fact, I just recently had a patient, a fantastic case, and he actually heard me on one of the podcasts where I was talking about auto-brewery syndrome. So I did a consult with him, and he ended up going and buying a breathalyzer. And he confirmed that he has auto-brewery syndrome, because he was producing alcohol.

Dr. Mark Hyman (17:18):
He was driving over the limit.

Dr. Todd LePine (17:21):
He was just short of the limit.

Dr. Mark Hyman (17:22):
That saves you money on beer, for sure.

Dr. Todd LePine (17:25):
It was actually quite interesting, because he actually was doing a very strict low-carb, no-sugar diet. And even with a really good diet, he was making alcohol. It was really quite interesting. So yeah. But anyway, so talking about how do we diagnose this, so you can do stool testing. I like the GI map test where you can do quantitative PCR for bacteria, yeast, fungi.

Dr. Mark Hyman (17:49):
That’s looking for the genetic material of the different bugs or whatever?

Dr. Todd LePine (17:52):
Yeah, it’s like CSI. Yeah, CSI. I find it to be a very helpful tool. You can also do the hydrogen methane breath test, although the thing about the hydrogen methane breath test is that I’ve had some patients who have significant irritable bowel, SIBO-type symptoms. They’re bloating-

Dr. Mark Hyman (18:09):
And they’re negative.

Dr. Todd LePine (18:10):
And they’re negative. And I think, based upon my reading of the literature, is that they’re probably producing hydrogen sulfide. And I think that when you just sort of get a history, they pass very foul-smelling gas, and it smells like rotten eggs. That’s usually the people that are producing hydrogen sulfide.

Dr. Mark Hyman (18:25):
Yeah. People don’t realize that cows just don’t produce methane. Humans can produce methane if you have this. And we measure that coming out in your breath. We measure hydrogen, and we have you take this drink. And that’s really a clue that there may be these bugs growing in there, and they have to be treated directly. And that can really help a lot of people.

Dr. Todd LePine (18:41):
Oh, huge, huge amounts.

Dr. Mark Hyman (18:43):
And it’s often missed.

Dr. Todd LePine (18:45):
It’s very much missed. And you also have to do the tests properly, because everybody produces small amounts of hydrogen and methane. It’s just that you want it lower down in the colon, and it really doesn’t become as much of a clinical issue. The other things to also think about in those types of patients is to make sure that they have sufficient amounts of stomach acid. Stomach acid is very, very important at helping with the proper digestion. So you can actually do testing for gastrin levels, and I’ve been surprised at how many people have high gastrin levels. So when you don’t have enough stomach acid, your body produces more gastrin, which is the hormone to pump out more hydrochloric acid.

Dr. Mark Hyman (19:23):
It’s like flogging a dead horse.

Dr. Todd LePine (19:25):
Exactly. Absolutely. And I would venture to say that most people’s issues are not high acid in the stomach. It’s low acid. It’s low acid.

Dr. Mark Hyman (19:33):
Yeah, then we’re taking more of these acid blockers, which by the way, also cause irritable bowel. So they help your heartburn, but they cause trouble below.

Dr. Todd LePine (19:40):
Now, there is a role for short-term use of these acid blockers. Like in the ICU, studies have shown they’ve been very helpful to prevent stress-induced ulcers and hospital-acquired pneumonia. But they’re really to be used short-term. And when you start using them long-term, they are very toxic. They are very toxic. They produce increased intestinal permeability. They cause malabsorption of nutrients, vitamin B-12, iron, other trace minerals.

Dr. Mark Hyman (20:09):
Magnesium, zinc, yeah.

Dr. Todd LePine (20:09):
Yeah, and they cause bacterial overgrowth.

Dr. Mark Hyman (20:12):
And they cause osteoporosis, and pneumonia.

Dr. Todd LePine (20:14):
Absolutely. Oh, yeah, huge, huge, huge. And I actually am really surprised that these things are over-the-counter. They really should not be over-the-counter.

Dr. Mark Hyman (20:23):
Yeah. No, I’ve talked about this before, but I remember when I was in medical school, these just came out, and the drug rep was like, “These are super powerful drugs. You never want to give them more than six weeks. They’re designed to treat ulcers. After six weeks, you’ve got to stop them. Don’t take them long-term.” And now people eat them like candy all day long, every day. And I’m like, “This is not good.” And we see so many complications from that. So if your irritable bowel is there, and you have these acid blockers that you’re taking, there might be a correlation.

Dr. Mark Hyman (20:48):
Hey, everybody, it’s Dr. Hyman. Thanks for tuning in to The Doctor’s Farmacy. I hope you’re loving this podcast. It’s one of my favorite things to do, and introduce to you all the experts that I know, and that I love, and that I’ve learned so much from. And I want to tell you about something else I’m doing, which is called Mark’s Picks. It’s my weekly newsletter, and in it, I share my favorite stuff, from foods, to supplements, to gadgets, to tools to enhance your health. It’s all the cool stuff that I use and that my team uses to optimize and enhance our health.

Dr. Mark Hyman (21:16):
And I’d love you to sign up for the weekly newsletter. I’ll only send it to you once a week, on Fridays. Nothing else, I promise. And all you do is go to to sign up. That’s, P-I-C-K-S, and sign up for the newsletter. And I’ll share with you my favorite stuff that I use to enhance my health, and get healthier, and better, and live younger longer. Now back to this week’s episode.

Dr. Mark Hyman (21:43):
So we talked about SIBO, and we can talk about how to treat that. But essentially it’s killing the bad bugs and reseeding the gut. And what other things are driving irritable bowel, besides that?

Dr. Todd LePine (21:54):
Well also, you can also potentially have problems with part of the intestine that causes peristalsis. So normally you think of the gut as this conveyor belt that’s always moving things through. So you eat, and within about 24 hours, everything should sort of move through. And there are some patients, especially patients who have problems with constipation, that will have problems with motility, what are really motility disorders. And there’s a test-

Dr. Mark Hyman (22:20):
Things are just not moving down?

Dr. Todd LePine (22:21):
Not moving down. And there’s a part of the intestines which is called the migrating motor complex, and you can actually test for antibodies against the migrating motor complex. It’s called IBSSure test, and I’ll do that in-

Dr. Mark Hyman (22:33):
It’s almost like an autoimmune thing.

Dr. Todd LePine (22:35):
Yeah. Or it’s a little bit like a paralysis, if you will, or a weakening of the gut. And we talked about that earlier, how in some cases, you’ll have patients who have Lyme disease. I actually had a very good integrative gastroenterologist who brought my attention to this. He had a lot of patients who had refractory SIBO. So SIBO is one of those things where it sometimes can come back, and oftentimes does come back. And what he was finding is that some of his more difficult patients with refractory SIBO actually had underlying Lyme disease, and Lyme disease affects the nervous system.

Dr. Todd LePine (23:07):
And he tied the two together, because there is a paper, it’s called Bell’s Palsy of the Gut … And, in fact, Bell’s palsy is where you get facial paralysis. And I’ll never forget this. When I was in my private practice, the first time I saw a real acute case of Lyme disease, the patient presented with Bell’s palsy, so her face was paralyzed. And I did testing on her, and the patient had acute Lyme disease. And that is one of the known complications. And the thought also that Lyme disease can actually affect the gut, and you get paralysis and decreased motility of the gut.

Dr. Mark Hyman (23:42):
Yeah. So that is a very important point, because there are the typical things that go on. Food sensitivities, gluten, dairy. Some people react to the chemicals in food that are food additives.

Dr. Todd LePine (23:54):
Food additives, food colorings.

Dr. Mark Hyman (23:55):
Food colorings, sugar alcohols.

Dr. Todd LePine (23:56):

Dr. Mark Hyman (23:57):
Emulsifiers, all these things that are in our junk and processed food do have a huge impact on people. There’s obviously the SIBO. So many people get parasites.

Dr. Todd LePine (24:06):
Yeah, little microscopic hitchhikers.

Dr. Mark Hyman (24:08):
Yeah, and there’s one called Blastocystis, which is really common. It doesn’t cause a horrible disease, but it can cause irritable bowel, and about 30% of people with IBS have this.

Dr. Todd LePine (24:17):
Oh, yeah. I’m going to venture to say that I have picked up a lot of these. I call them little microscopic hitchhikers. And when you actually look in the mainstream literature, they basically say that a lot of these, you don’t need to treat it. So there are times when somebody can … If they have Entamoeba histolytica, and Blastocystis, and sometimes Endolimax nana, and sometimes people will have these, and they’ll have a small amount of them, and they may not cause any symptoms whatsoever. But if I find them in the stool test, and patients are having symptoms, I treat them.

Dr. Mark Hyman (24:45):
Yeah, absolutely. And then there’s also other things. People have enzyme deficiencies we can see on stool tests, not digesting their food well. And also, for me, I had terrible irritable bowel, almost 30 years ago, and it was from mercury poisoning, because mercury affects all your enzymes. It basically interrupts the enzyme function of many different enzymes throughout your body, including your gut. And until I got rid of the mercury, my irritable bowel wouldn’t go away, no matter what I did. I just ate turkey, and broccoli, and brown rice for six months, and nothing worked.

Dr. Mark Hyman (25:18):
And so you have to keep being a detective and thinking about what are all the variable causes. And we look at the stool testing, we look at breath testing for bacterial overgrowth. We look at organic acid urine testing to see if there’s markers of bugs in there. And we sometimes dig down deeper to look at things like metals, or Lyme, or other tick infections. So there is a real deep thinking about what is going on with this person, and it’s guided by their history, right?

Dr. Todd LePine (25:43):
Exactly, yeah. And it’s personalized, it really is. It’s totally personalized, and it takes time to figure that out. And sometimes it may take several visits. I mean, you and I have had patients where we’ve been seeing them for a long, extended period of time. And they make some progress, they get better. They may backslide, then they’ll have incremental things. So we sort of uncover, as you say, the layers of the onion.

Dr. Mark Hyman (26:08):
Yeah. No, it’s true. I had a very bizarre case, once, that you just reminded me of, who was suffering terribly from digestive issues for years and years, was overall systemically inflamed. And it turned out he had Babesia, which affected his gut. He also had a histamine intolerance.

Dr. Todd LePine (26:26):
Histamine, yeah, that’s another one. Yeah.

Dr. Mark Hyman (26:28):
And there are histamines in food. And so we put him on a low-histamine diet. We treated his Babesia, and his symptoms got better. So sometimes it’s a little bit of a roundabout way to think about it. But what cases have you seen in your practice that have sort of stood out for you around irritable bowel?

Dr. Todd LePine (26:46):
Oh, I recently had a patient who came in with a diagnosis of irritable bowel. That was the official diagnosis. And interestingly, she gave me through the history that her symptoms seem to have been triggered when she had Lyme disease. And her Lyme disease also was complicated by POTS, which we’ve talked about before, which is postural orthostatic tachycardia, which basically means that you have autonomic nervous system dysfunction as relationship to Lyme. So that-

Dr. Mark Hyman (27:15):
It means when you stand up, you get dizzy.

Dr. Todd LePine (27:17):
Yeah. When you stand up, you get dizzy, and your heart starts going really fast. And so there are a couple of things that make me think about Lyme disease. So when I have a patient who’s got POTS … And sometimes people just come in, and that’s their only diagnosis, is POTS. I said, “Okay, well, why do they have POTS?”

Dr. Mark Hyman (27:34):
Yeah. I love medical terms. Postural orthostatic hypotension, which is called POTS. It sounds like a fancy diagnosis. What does it mean? It means when you stand up, your blood pressure drops. It doesn’t tell you anything about why or what caused it. And it’s so frustrating to me that nobody keeps thinking about what’s going on here with these patients so they can actually fix the problem.

Dr. Todd LePine (27:54):
Right, right. So this lady had this history of Lyme and POTS. And then she ended up having cancer of the uterus and went through radiation. She was supposed to get 25 rounds of radiation. And she had to stop at 12 because she developed diarrhea.

Dr. Mark Hyman (28:09):
They call it radiation colitis.

Dr. Todd LePine (28:12):
Radiation colitis, radiation enteritis. Exactly. And, believe it or not, the doctors who were treating her said, “Oh, that has nothing to do with your symptoms.” I mean, they literally … They didn’t want to-

Dr. Mark Hyman (28:23):
Admit that it was from the radiation?

Dr. Todd LePine (28:25):
Exactly. Exactly. Yeah, yeah. And then she came in, and she actually had had some testing done previously. And I think the doctor who actually did the testing didn’t know how to interpret the tests properly, but the patient’s calprotectin was elevated. So calprotectin is a biomarker in the gut. I call it CRP of the gut. So we have this compound which is called high-sensitivity C-reactive protein. When it’s elevated, it is a biomarker of systemic inflammation, and it’s also highly correlated with heart disease. And calprotectin is found in the gut, and it’s sort of like the CRP of the gut. So when you see that-

Dr. Mark Hyman (29:06):
The thing you see is high inflammation.

Dr. Todd LePine (29:07):
Yeah, exactly. So it tells you. And usually for classic … what we call irritable bowel syndrome, you don’t usually have inflammation, per se. There’s not really dramatic inflammation. There’s dysfunction, but there’s not inflammation. So her irritable bowel was actually partly inflammation, and I think that was one of the big things that was driving it. The other thing in this particular patient is that she had on her testing undetectable Akkermansia muciniphila.

Dr. Mark Hyman (29:34):
That’s a big word.

Dr. Todd LePine (29:35):
Yeah, right.

Dr. Mark Hyman (29:35):
What is that?

Dr. Todd LePine (29:36):
So it’s a mucus-loving bacteria. And what we’ve found is that higher levels of this is correlated with leaner body mass, less chance of obesity, less chance of diabetes. And you want to have higher levels of this because it’s a protective good bug. It’s not a probiotic.

Dr. Mark Hyman (29:56):
And it can also predict autoimmune disease and less risk of cancer [inaudible 00:29:59].

Dr. Todd LePine (29:59):
Yeah. And it’s not a bug that you can go out and get a pill for, at least not yet. Eventually we might, because it’s so beneficial. But what we find out is that this particular bacteria feeds on fibers, specifically polyphenols.

Dr. Mark Hyman (30:14):
And what are those?

Dr. Todd LePine (30:15):
Polyphenols are those compounds that are phytonutrients found in lots of colorful fruits and vegetables, things like pomegranate, and green tea, and-

Dr. Mark Hyman (30:24):

Dr. Todd LePine (30:25):
Cranberries, yeah.

Dr. Mark Hyman (30:26):
So your little bugs like cranberry, pomegranates, and green tea.

Dr. Todd LePine (30:29):
Exactly. They love that stuff. This is their … I call it the Miracle-Gro. It’s a miracle. You put this stuff on there, and the good bugs flourish.

Dr. Mark Hyman (30:37):
That’s a fairly new understanding, because we thought, “Okay, you need prebiotics, you need probiotics.” But I think the polyphenols are also critically important to optimizing your gut flora. The three Ps.

Dr. Todd LePine (30:48):
Yes, exactly. And the other thing, which I always come back to when I think about the digestive tract, is … It’s a beautiful visual, is the rainforest. And for anybody who knows about rainforests, rainforests are full of biodiversity. There’s lots of flora and fauna. There’s frogs, there’s birds, there’s all different plants, insects, worms. And the more biodiversity that you have in your personal internal rainforest, the healthier you’re going to be. And there’s tons of studies that have shown this. And it’s nonlinear. It’s very, very complex, because there’s this whole ecosystem, and there’s this cross-feeding and interaction that happens when you have a diverse internal rainforest.

Dr. Mark Hyman (31:29):
Yeah. It’s so true. I was talking to a professor at Harvard who’s a psychiatrist and also runs the department of nutritional psychiatry. And she’s written a book called This Is Your Brain On Food, talking about the microbiome and its effect on psychiatric illness.

Dr. Todd LePine (31:45):

Dr. Mark Hyman (31:45):
So we used to think that the crazy person would have the gut problems. It turns out the gut problem people have the crazy thing upstairs because of the gut thing. And fixing the gut fixes the depression, anxiety, OCD, all these crazy things that we thought of our psychiatric illnesses. It turns out they’re really related to the imbalances in the microbiome and the lower diversity. And Western societies have increasingly lower diversity.

Dr. Todd LePine (32:08):
Oh, huge. Huge, yeah. And it happens very, very early on. And what typically will happen is there are some people that they’re very picky eaters, and they’ll be eating the same food over, and over, and over. And I always tell patients that you want to try to increase your intake of diverse fruits, vegetables. Try to eat and see. Right now, in the Berkshires, we have lots of great vegetables that are available, that you may not get year-round. And eating … I call it, you want to eat a Crayola crayon box. The more color you have in your diet, the healthier your diet is going to be.

Dr. Mark Hyman (32:47):
And I want to come back to something you said before about this inflammation in the gut. There’s a whole new phenomenon we call pre-inflammatory bowel disease. So we thought irritable bowel wasn’t inflammatory. It turns out even if you can’t always detect it, it tends to be very inflammatory. And there are cases like you saw, people with this pre-IBD, so it’s like pre-Crohn’s or pre-colitis.

Dr. Todd LePine (33:07):
Yeah. It’s not like one night you wake up, and all of a sudden you’ve got Crohn’s disease. Yeah, exactly. Yeah.

Dr. Mark Hyman (33:10):
And so there’s this level of this marker we check, and it’s often elevated, and people have not full-blown Crohn’s disease, but something’s going on in there that’s driving inflammation. And you have to deal with those factors.

Dr. Todd LePine (33:22):
Exactly. Yeah, exactly.

Dr. Mark Hyman (33:24):
So this patient, she also had elevated gluten antibodies, right? So she had this low Akkermansia, she had-

Dr. Todd LePine (33:29):
Yeah, elevated-

Dr. Mark Hyman (33:30):
-elevated gluten antibodies, and this high calprotectin.

Dr. Todd LePine (33:33):

Dr. Mark Hyman (33:34):
And so this is sort of a perfect setup for having a messed-up gut.

Dr. Todd LePine (33:38):
Absolutely, yeah.

Dr. Mark Hyman (33:39):
So how would you take care of this patient who came in with the gluten issues, the low Akkermansia, and the calprotectin?

Dr. Todd LePine (33:46):
Well, I mean, to address the inflammation-

Dr. Mark Hyman (33:48):
And by the way, these are something that your traditional doctor will never look for, that we usually look for in functional medicine. At the UltraWellness Center, it’s sort of standard operating procedure for us to really look at these things.

Dr. Todd LePine (33:58):
Yeah. So, to treat inflammation, I always like to check the omega-3 fatty acids, because when you have low essential fatty acids, you’re a setup for inflammation. So in this particular patient, the patient had suboptimal omega-3 fatty acids, which are related to eating cold-water fish. So I got her to take some supplemental omega-3 fatty acids, had her increase her fish intake. I used an anti-inflammatory supplement called UltraInflamX, which it has a powder of curcumin and other things to help decrease inflammation in the gut.

Dr. Mark Hyman (34:32):
Ginger, rosemary.

Dr. Todd LePine (34:33):
Exactly, ginger and rosemary. Exactly. And then I also used EnteraGam, which is a immunoglobulin that helps with patients who have diarrhea-type … That’s actually a prescription medication.

Dr. Mark Hyman (34:45):
So tell us more about it. What is this immunoglobulin stuff, because you hear a lot about it?

Dr. Todd LePine (34:49):
Yeah, it’s serum bovine-derived immunoglobulin.

Dr. Mark Hyman (34:55):
It’s basically colostrum.

Dr. Todd LePine (34:55):
Yeah, you can think of it as like colostrum. And yeah, colostrum is the stuff in mother’s milk that is before the milk comes on.

Dr. Mark Hyman (35:02):
And it gives immunity to the baby.

Dr. Todd LePine (35:03):
Exactly. Yeah, it’s passive immunity. So it’s the mother’s immune system that’s passed down to the child, which is really quite amazing when you think about it from an evolutionary standpoint, that the mother’s immune system has evolved and learned what to deal with and how to deal with it. And then that immune system gets literally transferred in the breast milk to the baby.

Dr. Mark Hyman (35:26):
Until the baby can actually develop its own.

Dr. Todd LePine (35:28):
Exactly. Exactly. And the interesting thing is our immune system has to learn. It’s got to be educated. It’s got to go to school. And that’s why when you see these little kids who are crawling around on the ground, and they’re putting stuff in their mouth, we’re developing what’s called mucosal tolerance. It’s the immune system learning to deal with the planet Earth. And it realizes that, “Okay, you’re going to be around a lot of these things. You don’t want to overreact to it.” And so I know we always talk about, “What is a healthy immune system?” Well, a healthy immune system is a tolerant immune system.

Dr. Mark Hyman (35:59):
Yeah, it doesn’t overreact or underreact.

Dr. Todd LePine (36:01):
Exactly. That’s the key thing. And I say to people, “I want a strong immune system.” Well, if you have a too strong immune system, that’s called autoimmune disease, where your body’s reacting to everything, and it’s overreacting. So having tolerance and mucosal tolerance is really, really important.

Dr. Todd LePine (36:17):
And the other thing, which in some of the lectures I do, I like to emphasize this, is you can think of … We have the Boston Symphony Orchestra, and unfortunately Tanglewood is not open this season because of COVID. But in the Boston Symphony Orchestra, you have the conductor, and the conductor balances the woodwinds, and the strings, and everything, and they sort of keep everything in balance. And in the immune system, we have cells called the T-reg cells. And the T-reg cells regulate the immune system between the various parts of the-

Dr. Mark Hyman (36:49):
So make sure it’s not too hot and not too cold.

Dr. Todd LePine (36:50):
Exactly. Exactly. And guess what helps with T-reg cells? Fiber.

Dr. Mark Hyman (36:55):

Dr. Todd LePine (36:55):
Fiber, yes. So when you’re eating lots of fiber, you up-regulate your T-reg cells. Other things that can do that, vitamin A can do that, too. But fiber is probably one of the biggest things that helps with the T-reg cells.

Dr. Mark Hyman (37:07):
Yeah. And functional medicine is really practical, too, because when you have a patient with any condition, particularly with gut issues, which is often driving so many things. Even if you don’t have “Irritable bowel,” a lot of health conditions are driven by imbalances in the gut, like we talked about psychiatric issues, heart disease, obesity.

Dr. Mark Hyman (37:25):
But we have a very specific framework called the Five R program, which we use to methodically treat and restore gut function. And we’ve been doing it for decades. Even before people called it the microbiome, our goal was to really optimize the microbiome as a way of treating all sorts of diseases. So how would we do that in this patient? Obviously, you got rid of the gluten, right?

Dr. Todd LePine (37:46):
Mm-hmm (affirmative). Yeah, obviously, in a patient, to decrease inflammation, you can decrease the foods that typically drive inflammation. So things like trans fats can drive inflammation. Sugar drives inflammation. Dairy, big thing, especially cow’s milk. Sheep and goats tend to be less inflammatory. I’m not sure why that is.

Dr. Mark Hyman (38:11):
It’s the A2 casein.

Dr. Todd LePine (38:12):
Oh, A2, okay. There you go.

Dr. Mark Hyman (38:14):
Yeah, A1 casein is very inflammatory, which is all the modern cows. All the heirloom cows, and sheep, and goats still have A2 casein, which is less inflammatory. It tends to cause less digestive issues for people.

Dr. Todd LePine (38:25):
Yeah. And then gluten is a big driver. And then other things that are found in foods, like we’ve talked about things like emulsifiers and artificial-

Dr. Mark Hyman (38:34):
Processed foods.

Dr. Todd LePine (38:34):
Processed foods, exactly. If you can’t read it on a label, don’t eat it.

Dr. Mark Hyman (38:38):
Yeah, yeah.

Dr. Todd LePine (38:38):
Yeah, you don’t eat it. Another one, which is … I’ll mention this, is titanium dioxide.

Dr. Mark Hyman (38:44):
Yes, I was just reading about that.

Dr. Todd LePine (38:46):

Dr. Mark Hyman (38:46):
Tell us about that.

Dr. Todd LePine (38:47):
Yeah, it’s bad. It’s the thing that they add to food to … whitening. And they’ll use it in a lot of products. Gums, they use it in and such.

Dr. Mark Hyman (38:55):
It’s in a lot of vitamins you get at the drugstore, too.

Dr. Todd LePine (38:58):
Exactly. And titanium, your body does not like titanium. It’s a metal, and your body can react to it. And it’s almost like a nanoparticle metal that you’re putting in the body, and it’s been shown that the gut does not like it.

Dr. Mark Hyman (39:12):
Yeah, one more reason to not eat processed food.

Dr. Todd LePine (39:14):

Dr. Mark Hyman (39:14):
All right, so we’ve gotten … We’re removing the foods, we’re removing these processed ingredients, we’re removing trans fats, gluten, dairy, other food sensitivities. I had a patient, for example, who had diarrhea for years and years. It turned out she had a sensitivity to eggs. It wasn’t an allergy. She got rid of the eggs, and her diarrhea went away.

Dr. Todd LePine (39:30):
Yeah. And there are some times where doing a strict elimination diet to try to tease out … Because food is complex. There’s lots of things when you’re eating food. There are also some patients … I mean, you’ve probably done it yourself, where sometimes you’ve got to put them on what’s called an elemental diet, where you basically give them amino acids-

Dr. Mark Hyman (39:46):

Dr. Todd LePine (39:48):
Predigested, exactly. And that helps to sort of calm down and quiet the gut. In fact, mainstream doctors will do that for patients where they’ll actually put them on parenteral nutrition, where they just give them through the … They sort of rest the gut.

Dr. Mark Hyman (40:01):
Yeah. I mean, we’re going to be having a podcast with one of our nutritionists. We’re going to be talking about the elimination diet, and why we do it, and how we do it. And there’s lots of different versions, particularly for IBS. The FODMAP diet, there’s a specific carbohydrate diet, there’s a traditional elimination diet. So I think this is a really important thing, is to get rid of the things that are causing the problem. We look for parasites, and other bad bugs, SIBO, breath testing. So we actually clear out all the bad stuff.

Dr. Todd LePine (40:24):
Yep. Take out the bad and put in the good.

Dr. Mark Hyman (40:27):
And what’s the next step for how to repair the gut on the Five R program?

Dr. Todd LePine (40:31):
Well, you can reinoculate. Sometimes you can use probiotics along with prebiotics. We call that symbiotics. The big thing you’ve got to watch out with that, and you’ve probably seen this, is if you add that in too soon, you can actually sometimes flare up bloating symptoms.

Dr. Mark Hyman (40:45):
Yeah. It’s like a war between the good guys and the bad guys. You’ve got to clear out the bad guys first. I call it the weeding, seeding, and feeding program. First you’ve got to do the weeding. Then you’ve got to seed the good guys, and then you’ve got to feed them.

Dr. Todd LePine (40:55):
Yeah, exactly. Yeah, that’s exactly right. And then the other thing that’s also important, just that sort of helps with digestion, is … and I’ve been using this more and more, is stimulation of the vagus nerve. So the vagus nerve, we have the autonomic nervous system in the body, and my analogy is the gas pedal and the brakes. And the gas pedal is the sympathetic, so it sort of gets things going, and the brakes sort of slow things down. So the stimulating of the vagus nerve is resting and digesting, and that’s what you want to be doing. You want to be in a relaxed state when you’re digesting your food. And we tend to have a sympathetically-driven society. We’re running, going. We’re always on the go.

Dr. Mark Hyman (41:36):
It’s why people say prayers or grace before eating, to calm everything down, right?

Dr. Todd LePine (41:41):

Dr. Mark Hyman (41:41):
And we just kind of eat on the run, eat in the car, eat while walking down the street.

Dr. Todd LePine (41:45):
Yeah. And we’re all guilty of that.

Dr. Mark Hyman (41:47):
We eat while watching TV.

Dr. Todd LePine (41:48):
Yeah. The worst thing is actually … I call it unconscious eating. It’s like you’re sitting in front of watching a movie, and you’ve got the popcorn. And all of a sudden, the big bowl is gone.

Dr. Mark Hyman (41:56):
Well, they actually did those studies where they literally have a secret trap door on the bottom of the bowl, and they filled it up from the bottom. And people will just keep eating and eating.

Dr. Todd LePine (42:04):
Exactly, unconscious eating.

Dr. Mark Hyman (42:06):
They won’t stop.

Dr. Todd LePine (42:08):
Exactly. Exactly.

Dr. Mark Hyman (42:08):
Okay, so the Five R program is basically remove the bad stuff, basically replace the things that are missing.

Dr. Todd LePine (42:16):
The digestive enzymes, stomach acid.

Dr. Mark Hyman (42:17):
Like the digestive enzymes and prebiotics, reinoculate. And then repair, which is the next phase, which is how do you fix a leaky gut, right?

Dr. Todd LePine (42:24):
Yeah, and you talked about butyrate. Butyrate is one of the things that’s very helpful for a leaky gut, and I have been using that in supplement form. I also encourage fiber use. And glutamine can be very helpful. Aloe can be really helpful. Quercetin or other things-

Dr. Mark Hyman (42:44):
Vitamin A, zinc, fish oil.

Dr. Todd LePine (42:46):
Zinc, yeah. Zinc in the form of zinc carnosine, there’s some really interesting studies on that with leaky gut. Because when you take things like Advil or Aleve, those things cause transient leaky gut, so you’re going to develop leaky gut. And for people who are taking them chronically, they have shown that just taking zinc will help repair the gut with the [inaudible 00:43:08].

Dr. Mark Hyman (43:08):
So it’s really a very specific methodology of diagnosis and treatment. And the hit rate is pretty high on this. I mean, I think people come in with these chronic, lifelong digestive issues. I mean, I just talked to a patient yesterday, and she had been struggling, and struggling, and struggling. It turned out she had a parasite, she had bacterial overgrowth, she had all these issues. And within a couple of weeks, she was back to normal. And I think people are just sort of shocked. And one of the things you used on this patient is a gut shake that kind of combines a lot of these things, that helped grow her Akkermansia.

Dr. Todd LePine (43:38):
Exactly, yeah. So the gut shake is full of polyphenols. It contains things like cranberry, pomegranate, macha.

Dr. Mark Hyman (43:45):

Dr. Todd LePine (43:45):
Matcha, matcha. I called it macha.

Dr. Mark Hyman (43:49):
Green tea.

Dr. Todd LePine (43:50):
Matcha, matcha. Right, right, matcha, not macha.

Dr. Mark Hyman (43:52):
Yeah, and it’s got the immunoglobulins, which you talked about, that help kind of regulate the immune system in the gut. And prebiotic fibers, probiotics.

Dr. Todd LePine (44:02):
Yeah. And again, I call this … These are sort of like Miracle-Gro for your rainforest. It just helps with biodiversity. It helps with this flourishing of the good guys, which have their own way of keeping things in check. It really is.

Dr. Mark Hyman (44:17):
So for those listening who have irritable bowel, who have been suffering for a long time without help, there is help. You don’t have to suffer. It’s actually not that hard to fix. It’s sort of embarrassing how easy it is, once you know what to do. But most of us in medicine, we’re not trained on how to approach this systemically or systematically. And that’s sort of what functional medicine is. It’s a systematic approach that looks at the causes, and then restores normal function, hence the name functional medicine.

Dr. Mark Hyman (44:45):
And we’ve been doing this at the UltraWellness Center for, gosh, I don’t know, decades now. With all of us together, we probably have 65 years of clinical experience, and we all are faculty and teach all over the world. So I think your stories and my stories just go back so many years and help us really know that we have a way through this, and people don’t have to suffer. So if people are listening and struggling, I encourage you to get help through a functional medicine doctor.

Dr. Mark Hyman (45:10):
Here at the UltraWellness Center, we’re doing all virtual visits now. Well, we also … You can come in, for sure, but we do virtual, so you can get new patient virtual consults. And we’re really happy to help anybody who needs help, because this is a terrible problem to suffer with. And there are answers, and there’s a way to figure it out, and it ain’t that hard. And I personally have suffered from it, so I get it, and it’s just no fun.

Dr. Mark Hyman (45:30):
So I think, Todd, you are a wealth of knowledge, and I’m so glad to have you back on the podcast. And I’m just wondering out there, if you struggle with this, please share your story with us. Leave a comment, and subscribe wherever you get your podcasts. And we would love to have you share this with everybody, because I think there’s a lot of people out there with irritable bowel. And we’ll see you next time on The Doctor’s Farmacy.

Dr. Todd LePine (45:57):
We want everyone to have happy guts.

Dr. Mark Hyman (46:00):
Happy gut.

Dr. Todd LePine (46:00):
Happy gut.

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If you are looking for personalized medical support, we highly recommend contacting Dr. Hyman’s UltraWellness Center in Lenox, Massachusetts today.

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