Speaker 1:
Coming up on this episode of The Doctor’s Farmacy.
Dr. Emeran Mayer:
If you eat the things that are best for the health of your microbial system, you will automatically do the best for your health and for preventing or slowing cognitive decline and treating your depression.
Dr. Mark Hyman:
Hey, everyone, it’s Dr. Mark. Whole body wellness is obviously a huge part of my life and I’m always looking for new ways to make feeling great easier. One of my non-negotiables is getting a daily dose of healthy light. For years now, I’ve been using Joovv light therapy devices to easily do that all year long and I especially love it during these shorter cold winter days. You’ve probably heard me talk about Joovv before. That’s J-O-O-V-V. I use my Joovv light therapy device every day and I’ve experienced many benefits from firmer, more radiant skin to improved sleep quality and faster recovery from my toughest workouts. It works on a cellular level, which is why it has so many benefits for the whole body.
Dr. Mark Hyman:
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Dr. Mark Hyman:
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Dr. Mark Hyman:
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Dr. Mark Hyman:
Welcome to The Doctor’s Farmacy. I’m Dr. Mark Hyman and that’s Farmacy with an F, F-A-R-M-A-C-Y, a place for conversations that matter. Have you ever wondered about the gut and the brain and the immune system and this whole new microbiome revolution. And furthermore, the revolution in systems biology, network medicine, functional medicine, you got to listen up because we have an exceptional guest today, who is someone I’ve admired for many years. Followed his work, who’s really pioneered a lot of our thinking around the gut and the microbiome, and our immune system and our brain and many, many other aspects of the gut-microbiome environment.
Dr. Mark Hyman:
He’s studied these brain-body interactions for the last 40 years and is the Executive Director of the G. Oppenheimer Center for Neurobiology and Stress and Resilience. He’s a founding director of UCLA Brain-Gut-Microbiome Center at the University of California, Los Angeles. And his research has been supported by the NIH for the past 25 years and is considered a pioneer world leader in the area of the brain-gut-microbiome interactions and what they mean clinically. So, we have incredible guest, Dr. Emeran Mayer, who I’m thrilled to talk to. Welcome to The Doctor’s Farmacy.
Dr. Emeran Mayer:
Thanks for the kind words and thanks for having me on the show. A pleasure to be here.
Dr. Mark Hyman:
Well, of course, so your work has been so seminal because you’ve been able to connect dots where other people haven’t. And even the whole concept of a brain-body connection is sort of a novel idea for many practitioners. We were all taught that the brain is so this disconnected from the rest of our bodies to the blood brain barrier and what happens there stays there, a lot like Las Vegas, but actually, that’s not true. And you’ve come to this through your scientific work and I came to this through my clinical work. And I 15 years ago wrote the Ultra Mind Solution, which is about how the body affects the brain. And it’s just amazing about the convergence of deep science along with the experience of Functional Medicine practitioners over the last 30 years.
Dr. Mark Hyman:
So, we’re right now in a big crisis. Over the last 75 years, we have so many chronic diseases that have been flourishing: Cardiovascular disease, diabetes, metabolic syndrome, autoimmune diseases, cancer, all kinds of neurodegenerative brain diseases and mood disorders, cognitive disorders. They’re going up at extremely high rates. We’re living longer lives, but we’re also having shorter health spans. Meaning, our lives may be longer, but often we’re sick for many of the last years of our life. And we’re having a public health crisis at a massive scale and we’re seeing this being exposed by COVID-19, which has been affecting the chronically ill, the obese, and the elderly, who are all suffering from the effects of these various problems.
Dr. Mark Hyman:
How do we end up like this? How did we get here? Tell us a little bit about your perspective about this pandemic of chronic disease that we’re seeing.
Dr. Emeran Mayer:
Yeah, so I mean, first of all, it is I mean, I would say, you can’t call it a pandemic yet, because it’s not worldwide, but it does affect a lot of not just developed but developing countries. It’s definitely an epidemic and it has not gotten enough attention as a whole because what Medicine has done is it’s focused on individual diseases, like cardiovascular disease, degenerative brain diseases, and have sort of presented this as individual challenges for Medicine. But when you really look at it deeper, there’s so many similarities both in the time course that this has happened, since World War II gradually increasing rates. That there is when you look at it evidence for systemic immune activation, in almost all these disorders.
Dr. Emeran Mayer:
I still know early in my career that people noticed that, taking NSAIDs, anti-inflammatory, painkillers, that this was good for heart disease and for colon cancer. Nobody knew why that was. So, now we do know, because they all… the inflammation plays a big role. Well, we’ve also seen with some of these diseases that they have moved down to younger and younger age groups. That this particularly true for diabetes and metabolic syndrome and obesity, so that suggested some similar process going on. And obviously, a lot of things have happened the last 75 years in our lifestyles. But I think one thing that you can identify as a common, I would say it’s more than a risk factor, a common factor here is the change in our diet, particularly in the standard American diet, appropriately called with this acronym SAD.
Dr. Emeran Mayer:
So, that is definitely if you look at it, this comes down to the most likely common denominator for all these diseases. There’s obviously other things like pollution, air pollution, less exercise, more stress that has come with our advanced industrialized age. But yeah, diet, I would say, is the main factor that we can both identify, and this is the good thing we can focus on. So, in some ways, once you can agree on this, it doesn’t take rocket science how to deal with it, because if you know the target, the diet, but that’s not an easy task either.
Dr. Mark Hyman:
So, it seems as though we’re seeing this epidemic of chronic disease globally, it’s clearly linked to our inflammatory diet. And all these conditions that we’re seeing on the rise, whether they’re brain disorders like depression, or autism, or ADD, or Alzheimer’s, or whether they’re metabolic diseases like diabetes and heart disease, they’re all related to inflammation. This is common denominator, and it links together all these things. And as you mentioned, we’re so focused on the siloed approach to problems of the specialties and the particular pathways that we missed the interconnection of everything.
Dr. Mark Hyman:
And a lot of your work has really been focused on this emerging paradigm shift that’s happening in Medicine and Science. It’s still very hard for conventional Medicine to get their head around and it’s systems biology or network medicine, or I call it Functional Medicine, it’s understand how the body is one network. And really, it’s a network of networks of biological systems. All networked together. All dynamically changing in real time in response to what you eat, you think, you feel, your activity, exercise, stress, sleep, your nutritional status, environmental toxins. All the things that wash over us are all impacting our biological system, our ecosystem.
Dr. Mark Hyman:
And so tell us how you came to understand that what you learned in your academic career, what I learned in medical school don’t really tell the real story of how the body works. And then we’re going to get into discussing specifically your work around the microbiome, and the brain and the immune system and your new book, which is really, really exciting. I encourage everybody to get a copy of it. It is really one of the most important, I think, books written in a long time. And the book is called The Gut Immune Connection: How Understanding Why We’re Sick and Help Us Regain our Health. So, tell us how you’ve come to understand this whole paradigm shift from systems to Systems Biology and Network Medicine?
Dr. Emeran Mayer:
Yeah, so I mean, I’ve been fortunate in my career. I went through the whole gamut through the whole history of science, so to speak, because I did start it with a very reductionistic approach of studying ion channels on invisible ion channels on isolated cells, muscle cells, neurons, initially. Then I realized fairly soon that my clinical interest was always in these mind-body disorders. And I realized after several years of very exciting basic science that that could not explain what I see on my patients. Then as things went on, so we’ve studied model systems, a much more integrative way.
Dr. Emeran Mayer:
Then for a while, and I have to apologize to many of your viewers, they may not like the idea of animal experiments, but that was just a part of the basic of science and I was part of it. So. in retrospect, I would say, I wish I didn’t have had to do it, but, so we did very elaborate experiments on systems in mice, for example, of various cells in the brain and the microbes. And but then I realized, this was mainly focus on stress. And then I realized when we tried to translate these findings to humans, almost none of these translations worked. So, it was still way too reductionistic to have an isolated genetic identical mouse, and have these beautiful findings.
Dr. Emeran Mayer:
And then you try to see what happens in humans, so it didn’t work. So then, at some point, we decided, “Okay, I’m just going to human studies,” and we started. We’re the first ones to look at the brain, used brain imaging in these what’s called functional gastrointestinal disorders like irritable bowel syndrome. And so, initially, it was very easy, you saw these regions, blurbs that lit up. And then, so there was simple way of supposedly understanding the brain, but that changed rapidly to now what’s called the Human Connectome Project where these regions are no longer the focus of the research.
Dr. Emeran Mayer:
It’s the networks, the interacting networks within the brain of multiple, of thousands of regions. And it makes it explainable why it’s so difficult to understand that because a network is not a static thing. So, depending on what you do, a different network in the brain becomes active with the same network that was first the default mode network, the first when you didn’t do anything, all of suddenly do something, the same network all of a sudden becomes, has a different function.
Dr. Emeran Mayer:
Same thing with a microbe, so the Microbiome Science were the first ones to look at this in IBS. And then, the initial thing was very simple. We had a few microorganisms and the people associate those microorganisms with diseases, and it didn’t really work out. It was a very simplistic approach based on the traditional model of Microbiology that you have one organism that caused the disease. And very soon, I mean, the concept of the microbiome now, systems approach to trillions of these microbes that interact with each other in very complicated ways. And not only with each other, but also with us, with systems in the gut.
Dr. Emeran Mayer:
Then the gut of all places, you would never think that that’s such a complicated system because it’s there for digestion. If you look at it closely below the surface, you don’t see this with an endoscope, you see there is the biggest part of our immune system is in the gut. The biggest part of our nervous system outside the brain, so you’ve got the biggest part of the endocrine system. And each of those were studied in isolations by very smart people. But now, we realize the only way to understand the gut is by looking at how these systems interact, the immune system with the neurons and the hormonal system. So, all of a sudden, all these easily understandable mechanistic devices or organs that I started my career on, have sort of morphed into these, now, gigantic networks, interacting networks, as you say.
Dr. Emeran Mayer:
And as you know, it doesn’t start really with us. When you start to connect the microbes with our diet, then you go outside, outside the body and you look at these networks in in nature where the plants are growing. And so, it’s like, all of a sudden, you look at reality in a different way. And I personally believe the only way that we will get… it’s not the only way. The current way will very, very slowly get us there. But the only way to really understand and do actions that are healthy for us and for the environment is by looking at the world in a systems biological way.
Dr. Mark Hyman:
Yeah, it’s so important. And what I really love about the microbiome and your work particularly in the microbiome is that it’s the one area of science where it’s unequivocal that our old paradigm of siloed diseases and specialties totally breaks down. And it’s being recognized in the Medical literature, not just on the fringe, that the microbiome is connected to every single disease, almost. Whether it’s diabetes or obesity or heart disease or cancer, Alzheimer’s or autism, or depression, cancer. You just go on and on. Autoimmune disease, obviously. And so, all of a sudden, we’re having this opportunity to rethink all these conditions based on looking at the body as a network and looking at the gut is in ways the center of that network.
Dr. Mark Hyman:
And you mentioned that really, the gut is the immune system, the gut is the endocrine system, the gut is the nervous system, right? It’s like, “Wait a minute, I thought it was just a gut.” But it’s actually all of these things that dynamically interact together to determine the quality your health. And it is where the source of most of our inflammatory problems come from and your work has really helped us to understand that. So, how has this latest science shown us that changes in our gut microbiome are connected to so many of these chronic diseases and even infections like COVID? I mean, the microbiome and the health of the microbiome plays a role in our susceptibility to COVID-19 even. So, how are we learning about this? Tell us more about these links, and what the science has shown.
Dr. Emeran Mayer:
Well, so I mean, I should preface, I mean, this is still an evolving science. If you know 10% of the system, I think it’s a lot, I think there will be. And there’s different ways of looking at the connection between our diseases, the microbiome, and what role, for example, that the brain-gut-microbiome access or system plays in this. So, one is the microbiome is an ecosystem, so we know a lot about ecosystems, about diversity. We know about relative abundances, richness. So, all this isn’t not by coincidence, a lot of researchers, early research in the microbiome field came from ecology. They were ecologists, because they could relate to this.
Dr. Emeran Mayer:
So, we’re very good as humans in destroying diversity all over the place, all over the planet, certainly in our environment, in just about anywhere in any dimension. And we know that a change in the diversity and richness will lead to a decreased stability, resilience of the microbiome to perturbations, any perturbation. And you can substitute, I’d like to substitute stress for perturbations, because it’s stress from our diet and stress from our brain, bringing down to microbe that caused these perturbations. So, if you compare ourselves, for example, with people that live on the last remnants of hunter-gatherers on the Orinoco River, the Yanomami, which I was fortunate to in my college time to be on the film expedition…
Dr. Mark Hyman:
Wow.
Dr. Emeran Mayer:
… for six weeks, and lived with them, so I never thought-
Dr. Mark Hyman:
Wow.
Dr. Emeran Mayer:
So, I never thought that they would come back in my focus of interest. If we compare our microbiome with these individuals, they have the richest and most diverse microbiome than anybody in the world. And having lived with them and having seen their dietary, it’s-
Dr. Mark Hyman:
Wow. So, these hunter-gatherers that are in Amazon?
Dr. Emeran Mayer:
Yeah. And sadly, they’ve been affected a lot by COVID in Brazil, so these people may actually disappear. Many of the areas that we stayed in, I’ve read about, with a lot of sad feelings, were destroyed or wiped out from disease. And also by miners that come in, Brazilians. So, anyway, that wisdom and how they lived totally adapted to the jungle and the natural environment to the wild animals. And it always, in retrospect, fascinated me. So, they are surrounded by any species of animal and fish that you can imagine in great abundance, but they only eat a very small portion of them. Their meat is an unusual part of their diet. They live off of all the plant-based foods that that surrounds them as well. So, it’s a natural element of a very wise attitude towards the environment.
Dr. Emeran Mayer:
And anyway, so we talked about the importance of an ecosystem resilience, diversity, richness. And then you have a second thing, which is the relative abundance of certain microbes. So, we have identified some of them as the good guys, mainly because we have identified them as the good guys because they produce substances, like short chain fatty acids that have a lot of good effects on our gut in our body. So, they’re so-called butyrate producers. So, all the microbes that produce these short chain fatty acids from plant-based fiber, we can say is a group of beneficial microbes that we have in our gut.
Dr. Emeran Mayer:
And then there’s a few that are involved in other functions like mucus-production or that regulating the sickness of the mucus in the gut, in the layer, insulating our immune system.
Dr. Mark Hyman:
Like Akkermansia?
Dr. Emeran Mayer:
Yeah, like Akkermansia. That’s kind of a controversial species, because it’s been involved both in or implicated both in good and bad aspects of the… it degrades the mucus, so it’s not a mucus-stimulating organism. It degrades the mucus, and we normally don’t want to break down the mucus layer, so it’s still an incomplete understood system. But then we have the third thing, so I talked about the short chain fatty acids. We have these tens to hundreds of thousands of molecules that these microbes produce and that’s really one of the most important factors. How do these, and again, we’re dealing with networks, tens to hundreds of thousands of distinct chemical entities that are produced by these microbes, and that interact with our gut, are partially absorbed. They interact with the nerve cells of the gut to the immune cells.
Dr. Emeran Mayer:
So, for example, all the microbes that interact with, through their metabolites or signaling molecules with the serotonin containing cells in the gut, that’s another group of mechanisms. So, I would say, we have on a big scale, the health diversity and richness of the ecosystem. We have the number of beneficial microbes that live in that ecosystem, that produce things that we know today are good for us. And then we have this, and we started really starting to look into this new universe of metabolites that interact with each other, and are ultimately responsible for the health promoting effects. So, it’s a complicated system, but I think we have already identified a couple of things, diversity and short chain fatty acid production as sort of major factors.
Dr. Mark Hyman:
Yeah, so is there a perfect poop? Is there a perfect microbiome? Is the indigenous microbiome that you found in the Yanomami Indians in the Amazon something we should be striving for? How do we create that? If that exists in them and they don’t have all these chronic Western diseases, is there a way to sort of help us to rebuild that through our own diet or other aspects?
Dr. Mark Hyman:
And the another is sort of phenomenon, that is so fascinating to me of microbiome. And I love your sort of insights in this is talking to Stan Hays in the Cleveland Clinic and he said maybe up to a third or half of all the metabolites in our bloodstream are non-human metabolites. There are things that are produced by bacteria in our gut when they eat certain things that we eat and then they get absorbed, and are circulating around in us, and help regulate all sorts of things good or bad.
Dr. Mark Hyman:
If they’re the bad molecules that have come from bad bugs in your gut from basically a corrupt microbiome or unhealthy microbiome, it can cause havoc on your health. But if it’s from the right bacteria that are producing the right molecules that our bodies actually thrive with, so can you tell us more about that whole interaction between because it’s not just about leaky gut. It’s not just about the effects on that particular system, but it’s really a much bigger story.
Dr. Emeran Mayer:
Yeah. I mean, maybe if we can come back to the leaky gut, because I mean, that is obviously an interesting-
Dr. Mark Hyman:
Yeah, yeah.
Dr. Emeran Mayer:
One interesting assay that we have understood from the others. Yeah, but what these microbes produce, they’re the source of these molecules that they produce several fold. The biggest part is diet, dietary components. Many fiber products from indigestible fiber from plant sources. Another group of molecules is those that our body produces like bile acids, sex hormones, that are excreted through the bile into our intestine and the microbes modify those molecules. So, they can be reabsorbed and get back into our body and have all kinds of effects on, for example, estrogen levels in our blood are too large to be influenced by these microbes, particularly after menopause.
Dr. Emeran Mayer:
And bile acids have become a major factor. And as you said, I mean there are good ones and bad ones. Nothing is simple in this world. So, in general, people have always said that bile acids is good for the brain, for brain health. But then there’s secondary bile acids that are now implicated after having been found in the brains of postmortem brains of people with Alzheimer disease that seemed to be playing a role in neuro degeneration and predict the transition from mild cognitive decline to full-blown Alzheimer’s disease.
Dr. Emeran Mayer:
And then there’s a third group of molecules that are actually part of the microbes themselves in their cell wall, so like for polysaccharides or a whole group of molecules [inaudible 00:27:33] that interact directly with the immune system. So, we have food-related signaling mechanisms, we have mechanisms that are related to microbes breaking down or modifying our own molecules in our body, and the third one is the membrane molecules directly talk to the immune system.
Dr. Emeran Mayer:
And I mean, one of the best examples, the best studies examples of the first one is what happens with the essential amino acid tryptophan. So, tryptophan can be analyzed by certain microbes or the microbes can help in metabolizing tryptophan into serotonin. This happens in these specialized cells in the gut, but the signals to stimulate that conversion come from the microbes. The microbes talk to our gut cells, turn tryptophan into serotonin. Most of the serotonin our body is in these cells in the gut.
Dr. Emeran Mayer:
A second, but that’s not the only thing that the microbes do with tryptophan, they also turn into something called, unpronounceable name, kynurenine, which is a really bad guy. It’s involved in neuro inflammation and neurodegeneration. And the ratio of serotonin production, kynurenine production is influenced by another group of microbes. So, under chronic stress, you will produce more kynurenine, the bad one and less serotonin.
Dr. Emeran Mayer:
And then there’s the third one, which is called the indoles and the indoles, again, have been implicated for both positive and negative health effects. But there’s one, 17-hydroxyindole, indoxyl sulfate, which has now popped up in studies in Alzheimer’s disease, the autism spectrum disorder, and also depression. So, this is just one amino acid, tryptophan.
Dr. Mark Hyman:
Wow.
Dr. Emeran Mayer:
So, there’s other amino acids. And we probably have a lot more these other metabolites that are being generated, but it opens up like whenever you look at one of those pathways, it opens up into its own universe. So, it’s intimidating in some ways. Are we ever going to understand this? On the other hand, I think we know, we’ve learned a lot in the last 10 years what this has really become the focus of science.
Dr. Mark Hyman:
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Dr. Mark Hyman:
So, diet plays a huge role in regulating what bugs are growing or not growing and how they affect everything from our mood to our weight and our cognitive function. But what’s fascinating is that the other direction also affects us. In other words, our thoughts and feelings and emotions and stress, actually create a feedback loop to the gut, that can actually cause damage to the gut, alter the bacteria, create a leaky gut, create inflammation, that actually is almost the same as eating a bad diet. Can you explain that?
Dr. Emeran Mayer:
Yeah, so this is the intriguing thing. So, you asked me earlier, why are we… I mean, how do we end up where we are today?
Dr. Mark Hyman:
Yeah.
Dr. Emeran Mayer:
One is the diet, but the other one is the top down influence of our minds and our chronically stressed brains. Our brains are not developed for that, so we developed very effective acute stress response systems that saved us human species from extinction many times. But these systems are not designed as adaptive for chronic ongoing stress, which we experienced, obviously, just the last year. We’ve seen the impact of that on people’s lives. And the chronic stress will not go away now that the pandemic will be ending. There’s enough other factors.
Dr. Emeran Mayer:
So, what the brain does and I’d like to call it the brain-gut-microbiome system rather than an access because it is a bi-directional system, brain talking to the gut, gut talking back to the brain. And the signals that the brain sends via the sympathetic nervous system can talk directly to the microbes. They make them more aggressive, changes their gene expression patterns and the way they interact with us as the host. But they also indirectly change the microbial abundances by changing the peristalsis and the motility and transits the secretion of fluids into the gut. So, when you experience the microbes live in a totally different world.
Dr. Mark Hyman:
Wow.
Dr. Emeran Mayer:
I think a few in a relaxed state. And what is one repeatedly, long before the diet-related leaky gut syndrome came, appeared, is that both severe acute stress and chronic stress can increase the permeability of the gut, decrease the mucous layer and lead to a low-grade immune activation at the gut level. So, now imagine, in our world an unhealthy diet that does exactly the same thing together with these brain influences, it’s the worst thing we can do to our gut cells.
Dr. Mark Hyman:
A catastrophe.
Dr. Emeran Mayer:
And since gut cells help us to [inaudible 00:35:04], it [inaudible 00:35:05]. So, I think that’s really that.
Dr. Mark Hyman:
Yeah, I think that’s so key. I mean, everything we do affects this inner garden. We just thought it was just inert waste material and now, we’re recognizing, it is regulating almost everything in our body. And that the key to health and longevity is to optimize our inner garden and if you know how to do that. And fascinating thing to me was, when I saw in my practice, and this was decades ago, how the gut-microbiome. We didn’t even have the word microbiome back then, but the gut flora affected the cognitive emotional functioning of my patients.
Dr. Mark Hyman:
And I’ve stored up the story of cases of ADD or behavioral problems or depression, or neurodegenerative diseases, when you fix the gut, which we did as sort of a matter of course in the Functional Medicine to address physical problems, that the mental or cognitive problems would get better. And sometimes in striking ways. And we wouldn’t be able to measure the imbalances in rich flora, the overgrowth of certain bacteria, the overgrowth of fungal components and how those had huge implications for their cognitive function. And by treating them, people would get better.
Dr. Mark Hyman:
So, what do you see in terms of the therapeutic strategies we need to be using now for chronic disease? Because when you go to the cardiologist or you go to the dermatologist, or you go to psychiatrist, they’re not saying, “Could I please have a stool sample? I want to analyze your microbiome and tell you what you need to do to make it right.” They’re giving you the regular medication for their particular disease. How do we get past that hump in Medicine and start to really have doctors and the system as a whole start to take this into account? And what are these ways in which the microbiome specifically is affecting the brain? You mentioned tryptophan, but I think there are others.
Dr. Emeran Mayer:
Yeah, I mean, there’s many other of these so-called neuro active metabolites, for example. They’re being generated by the microbes and the relative abundances of this, it’s a combinatorial system. The relative abundance is these microbes determine ultimately what the output to the brain or to, I mean, it’s not only the brain, it’s other organs as well. But having been interested in IBS for a long part of my career, now this has expanded to cognitive decline and to psychiatric disorders.
Dr. Emeran Mayer:
I’ve seen the same thing as you do and I have to say, the experience that I had being in the middle of the conventional medicine world at a university was ignorance and total rejection at meetings. So, the whole brain system was something that people either were not interested in or put away as psychological, hysterical stuff. I have a quote from a very prominent colleague, who called this the disease of neurotic housewives.
Dr. Mark Hyman:
Irritable bowel, you mean? Yeah.
Dr. Emeran Mayer:
So-
Dr. Mark Hyman:
That’s what we learned in medical school. It was just people who were anxious and crazy and it wasn’t really because of anything physical or dysfunctional. But it turns out, we were just never good at looking, right? So, it’s like saying, “Well, we won’t be able to see bacteria until we get microscope,” right? So, now we have a different kind of lens to look at all these conditions and we see these connections that we didn’t before.
Dr. Emeran Mayer:
But, I think I give you in Functional Medicine a lot of credit here because the merchants of that type of Medicine, and not that I agree with everything being a skeptical with some of this.
Dr. Mark Hyman:
Sure, sure.
Dr. Emeran Mayer:
I still have some-
Dr. Mark Hyman:
I don’t review everything either.
Dr. Emeran Mayer:
If I can’t [inaudible 00:38:43]. But on the other hand, I think [inaudible 00:38:48] tremendous influence because all of our patients have already been to a Functional Medicine doctor. And they come with these concepts. And if we’re open-minded at the university, you would actually learn a lot. So, for example, the leaky gut, I learned from my patients, learned it from physicians like yourself, long before this became an accepted term. So, I think that the system will gradually change. I mean, there’s now like at UCLA or other places, like GI wellness programs that deal with relaxation, mindfulness based stress reduction, diet, sleep. So, they really look at the whole human being rather than just the organ or the ulcer or whatever.
Dr. Emeran Mayer:
In Psychiatry, I think it will be slower. I think most psychiatrists are still very skeptical, that this plays a big role. And we I think we need to find, we need to get examples of and unfortunately, this will take well-controlled, randomized controlled studies to convince much of the medical world that this is actually happening. I mean, I can really hear it now people say, “Oh, there was all this excitement, like when you wrote your book about the mind-gut connection, but I haven’t heard anything about this. Is that really true or was this just a fad?” You know that?
Dr. Mark Hyman:
Yeah, yeah, I know.
Dr. Emeran Mayer:
So, there’s still this skepticism by the traditional medical establishment that this is not something important. We should also keep in mind many of the medications that are being used, for example, in Psychiatry, are also metabolized by the microbes. So, what we ultimately what our brain sees is actually influence, but what the microbes do with it. And that again is determined by what microbes you have and what diet you’re on. So, it’s this link.
Dr. Emeran Mayer:
I think what’s going to be easier and I see that trend already, there’s a field now called Nutritional Psychiatry that is gaining [crosstalk 00:41:07]. And I think it’s going to be easier through the dietary path and as physicians are being trained in this whereas I had maybe one hour of education in nutrition and microbes.
Dr. Mark Hyman:
It’s not much better now.
Dr. Emeran Mayer:
But I think this… yeah, it’s not much better now. But I think this will be changing. I’ve seen trends that’s going in this direction. Younger physicians that come to us and do research with us in our center. They’re extremely interested in that and really want to pursue those kind of avenues. But I mean, I should say another thing what will slow this process, you make a lot more money with a traditional, with a conventional medicine, with the procedures.
Dr. Emeran Mayer:
And so, for example, as the gastroenterologist, so we now know that people get colon cancer earlier than early age. And so, the way the medical system has responded to this, so let’s move colon cancer screening guidelines to start at 40 instead of 50. So, putting 10 years ago and moving it to 30 years of age, and when somebody gave a lecture about this a few years ago in our division, I was asking, “Do you guys do any dietary assessment on these people that develop colon cancer at age 40?” They said, “Well, that’s actually a good idea. We should look into this.” I mean-
Dr. Mark Hyman:
What a concept?
Dr. Emeran Mayer:
It was just, it was amazing to me. But that shows you, what a concept, yeah.
Dr. Mark Hyman:
When you think about it, you put pounds of food every day in your gut.
Dr. Emeran Mayer:
But you make more money doing colon cancer than [inaudible 00:42:46].
Dr. Mark Hyman:
Right? Yeah, that’s true you make more money. But you put pounds of food in your gut every day. How do gastroenterologists not think that food has anything to do with digestive disorders? It’s just, it’s amazing to me, actually. “Oh, you need more fiber if you’re constipated or avoid these foods if you have reflux,” but it’s very limited and superficial.
Dr. Mark Hyman:
So, if you had patients coming to you with mood disorders or neurodegenerative disorders, how would you approach treating them through the gut?
Dr. Emeran Mayer:
Yeah, so I first of all, I start to explain to them this concept of the brain-gut-microbiome system and has influence by both the brain and the gut and a diet. I present them with a very wholistic model of treatment that we want to target all the parts of this brain-gut-microbiome system, at the same time that I don’t think a single approach, just limiting it to diet will be sufficient. So, there’s the regular moderate exercise. I mean, all the things that we know are beneficial, looking at your sleep, stress reduction.
Dr. Emeran Mayer:
With depression, it depends on the amount of anxiety and depression that’s actually there. I almost always now that we have these simpler versions, for example of cognitive behavioral therapy, the online systems that are coming, rapidly becoming available, anybody can do it from their home in 10 sessions. So, I recommend all these things plus the diet. And from a dietary standpoint, I mean, obviously, this is a minefield, as you know better than anybody else.
Dr. Mark Hyman:
Sure.
Dr. Emeran Mayer:
I’ve come to this conclusion and pushes them in my book that if you eat the things that are best for the health of your microbial system, you will automatically do the best for your health and for preventing or slowing cognitive decline and treating your depression. Depression if you have a severe form of major depressive disorder, I don’t think diet alone will do it. I think you will have to combine it with medication, at least initially. And then if you get into remission, as a maintenance, you can rely on your diet part there. But I always look at these multiple channels that we have to access the brain-gut-microbiome access. And this diet-
Dr. Mark Hyman:
Yeah, so it’s our diet.
Dr. Emeran Mayer:
Yeah, the microbiome-targeted diet makes it easy. You don’t have to argue how many grams of protein are the best for you and how many grams of you know carbs or what percentage, I think it becomes very simple. Microbes love complex carbohydrates that they break down into health-promoting molecules, such as short chain fatty acids, so it’s very simple.
Dr. Emeran Mayer:
So, I don’t know, how this is going to be perceived that recommendation once the book comes out, but I certainly have thought about this a lot. And could get a philosophical twist to that as well, that microbes are the most abundant and ancient life form on this planet, so they know exactly what’s best for the planet and the creatures that live in it. So, providing them with the healthiest food will take care of us, too and the environment. As we know, a largely plant-based diet has been beneficial for environmental reasons.
Dr. Mark Hyman:
So, I wouldn’t… just to sort of summarize a little bit here, because what you’re saying essentially is that we can treat a whole host of chronic diseases that are in origin, inflammatory, including all of the brain diseases, including depression, which is inflammatory, as autism and ADD and Alzheimer’s, these are all brain inflammation diseases. So, what you’re saying is we can alter the course of these conditions by changing our microbiome. And a lot of it has to do with our diet, with exercise, stress reduction, sleep, and maybe some other things that we haven’t really talked about, such as whether there’s probiotics or prebiotics, or things that can help fix the gut.
Dr. Mark Hyman:
So, talk about how we sort of need to sort of eat differently specifically for the microbiome. You mentioned, plant, I’d like to call it plant-rich diet. But how do we design a way of eating that facilitates a similar kind of microbiome, for example, as a hunter-gatherers? We all need to be paleo as we call it or what should we be doing?
Dr. Emeran Mayer:
Yeah, I would say, I mean, I stay away from these categories like paleo or keto, because I think it’s so contaminated by political and personal, strong personal feelings that. I actually went to get a blurb from a book from a prominent person in this diet field and he didn’t like that in my book, there was one sentence about eating fish and chicken. And he said, “He cannot write a blurb for a book if it has that sentence, if I will change it?” And I said, “No, I’m not going to change it.” But this is the kind of world I think that we have gotten into that people are so fanatic about certain types of diets. So, I would say the things you want to do is you want to create as many different microbes or nurture as many different microbes as possible. And since they’re all specialized in different types of fibers and different types of polyphenols, the greater variety of the food, the more we force the system to diversify. And that’s really the whole goal in it.
Dr. Emeran Mayer:
And then continuing this, this doesn’t help just to do it once. You have to rechange your lifestyle. This has to become a permanent way of eating. Then you nurture the richness and the abundance of this expanded ecosystem. We know we can’t go back to the ones with the hunter-gatherers or some people the Hadza in East Africa, because some of them sadly, some of these microbes have actually disappeared or extinct. Just like we can bring back the animals that have gone extinct, even though, yeah, kinetic engineering CRISPR may make that possible again. But, so we can’t, well, we can bring back about, I think we can reach about 80% of that, these kind of systems if we stick to a diet like this.
Dr. Emeran Mayer:
And I would say in addition to the variety, different types of fiber plants, fruits and vegetables, it’s also external microbes. So, you mentioned probiotics. I personally would recommend if you have access to natural and if you like the taste of natural probiotics and fermented vegetable or dairy products go with that. If you don’t have access, take a supplement, which is often a challenge, because there’s not enough controlled trials that would actually show you, “This one is better than this one.” So, the way people have dealt with it, so you mix a whole bunch of them together in very high concentrations. We won’t know if that mix is actually better than if you had a couple, if that made the big difference.
Dr. Emeran Mayer:
But if you look at countries like Korea that that consumed a vast amount of fermented products from childhood, from infancy on, I would love to do a study on these chronic diseases if there’s actually an impact on that, but the study has not happened so far, to my knowledge. But this is what I would recommend. And there’s also one thing that I think it’s really important to mention. It’s not just what we eat, but also when we eat it. So, there’s always three things that I think: What we eat, when we eat it, and where does it come from. Those are the three main [crosstalk 00:51:33] I think you should make.
Dr. Emeran Mayer:
So, when we eat, as you know and as the audience knows, there’s a lot of these intermittent fasting strategies. Beautiful results in animal models, me being the big skeptic of animal models from my own personal negative, the human studies are not as convincing, because they’re more difficult to do. They have started now randomized controlled trials. Of all these strategies, I personally liked the time restricted eating, because I think it’s the most realistic. There are studies now on the microbiome that actually that positively affects the microbiome is that mice that are on time restricted eating can actually eat what’s called a cafeteria diet, a very unhealthy diet without developing metabolic syndrome. So just-
Dr. Mark Hyman:
But that works better when you eat healthy, though. I’ve seen those types of-
Dr. Emeran Mayer:
Yeah, it definitely works better, yeah. So, and this goes sort of into this whole concept of the keto diet, so in a ketogenic state for 18, for 16 hours, if your first meal of the day is at noon time and it’s without any carbs and sugar, you can extend this ketogenic periods even longer. And so you get multiple benefits. And so, we’ve started this during the pandemic in our family and it actually works really well. It’s feasible. I’m not sure if I could fast two days a week on a regular basis, even if I wanted to do it. But the time-restricted eating, I think, is something.
Dr. Emeran Mayer:
So, combining that kind of microbiome-targeted diet, largely plant-based with the compression of the time when you eat it, I think right now, in my opinion, is sort of the optimal way of influencing your metabolic health.
Dr. Mark Hyman:
Yeah. And in your book, The Gut-Immune Connection: How Understanding Why We’re Sick and Help Us Regain Our Health, you talk about something called the gut-microbiome diet, which is rather than focusing on the traditional macro/micronutrients, we’re talking about how we wholistically in a way that feeds our inner garden. And that’s a very different paradigm.
Dr. Mark Hyman:
And really, in Functional Medicine, the way we start almost all our patients is by getting their gut right. And we try to do that through food and through the right lifestyle factors, supplements, sometimes resetting their gut through cleaning out the bad bugs. But it’s an interesting idea that we have if we focus on a way of eating that facilitates a healthy microbiome, we can address all hosts of downstream chronic inflammatory diseases.
Dr. Emeran Mayer:
Which is in some ways, I mean, it sounds simplistic. It almost sounds like the string theory of chronic diseases. But I’ve spent a lot of time thinking about this, and I think it makes a lot of sense. Now, the unfortunate thing is not everybody can do this. So, we haven’t talked about this. I mean, like we’ve seen in COVID epidemic, how the racial and socio-economic disparities, that a lot of people don’t have access to that diet or it’s a lot more expensive than hamburgers. Two for one hamburgers for $2.50, which is a completely ridiculous price. But that unfortunately becomes the diet of a lot of people that can’t afford the other one. They certainly don’t have the money to buy supplements.
Dr. Emeran Mayer:
So, this is a whole other question. And unfortunately, it’s this part of the population that is most severely affected by these chronic diseases and COVID, as well. So, how to deal with that issue is another, it’s other whole other challenge.
Dr. Mark Hyman:
Yeah. We delved in a very sort of human centric in our thinking, and what you bring up in the book is a different way of thinking about a relationship to our environment that our own microbiome is connected to the microbiome of the soil. That what we eat, how we grow our food, how that impacts the environment, how that affects the planet, all are related and that we can’t treat one without the other. And a lot of the podcasts I’ve had and the work I’ve done in my food-fix book has really been focusing on the bigger ecosystem of our food system and how it’s creating the food that we’re eating in a way that’s damaging the soil microbiome, that’s damaging our own microbiome.
Dr. Mark Hyman:
I mean, even glyphosate, which we use, for example, in massive amounts, and which we have discussed on this podcast, destroys the microbiome of the soil and our own microbiome and it’s prevalent. It’s on everything. So, help us connect the dots between the soil microbiome, our microbiome, and the overall health of the plant and the planet.
Dr. Emeran Mayer:
Yeah, I mean, I should say, one insight I also gained is the interactions of our gut microbiome with our gut, is in many ways very similar to the interactions of the soil microbiome with the root system, the rhizome of the plants, all the way down to some very amazing details. That plants secrete carbohydrate-rich sugar like molecules in the root system when they’re in trouble, which attracts the microbes to gobble down delivery of this, just like in our gut. There’s microbes living that can live off the mucus layer, which is also carbohydrate, a sugar layer.
Dr. Emeran Mayer:
And just that concept that plants depend on the microbiome for many functions on the soil microbiome, but mainly to defend against disease, so against and stress UV light, drought, pests, insects. A whole range of diseases, that plants sent down these distressed molecules through their root system, and attract the microbes from the environment that then form very close interactions and stimulate the plant to produce polyphenols. These same molecules that we now know are so healthy for us. And then these polyphenols go back up in the plant, to the leaf and to the seeds, and to the fruit to protect those assays of the plant.
Dr. Emeran Mayer:
I just find it absolutely amazing that these same molecules that the microbes stimulate in the plants to help the plant health are we ingesting and we’re dependent on the microbes to break them down into smaller molecules that can then do the same thing in our system. They can be absorbed and go through our distressed organs, including our brain. And it’s beautiful how nature has done that. So, it’s a design principle, I think that worked so well for the plants that evolution decided, “Let’s stick with it.” It works for humans as well, over animals as well.
Dr. Mark Hyman:
So, it’s a real symbiotic relationship between the microbiome in our bodies in our own health, and the microbiome, in the soil and the plant health, and then plant health also determines our health. So, one of the things that really is critical about are these polyphenols that are these plant compounds, we call them phytochemicals, these medicinal compounds, you call them the healthcare system of plants. And that the truth about our current way of farming and growing food is that growing food has got less and less of these beneficial compounds because of how we bred the plants, because of the quality or lack thereof of the soil and the organic matter in the soil.
Dr. Mark Hyman:
So, how does the soil microbiomes affect the polyphenol content of the plants? And why are these polyphenols so important for our own microbiome? Because I think this is an insight I’ve had over decades of doing this, that I didn’t really realize until recently that polyphenols are such a critical component of the health of your microbiome, that they feed a lot of the good guys. So, can you talk about the intersection of the soil problems we’re having, the lack of polyphenols in our food or the decrease in polyphenols, and its impact on our health overall and our microbiome’s health?
Dr. Emeran Mayer:
Yeah, so what has happened with the soil microbes and the polyphenol production, it’s the same thing that we’ve done with antibiotics to our gut microbiome. We have compromised it. And so, I mean, like the whole range of autoimmune and allergic diseases can be traced back to this early life exposure to antibiotics. I looked at the chemicals, so chemical agriculture, which is basically industrial agriculture, has replaced the natural system. And has killed a lot of these natural systems of healthcare, which was intricately connected with the polyphenols.
Dr. Emeran Mayer:
And there’s some studies, so there’s now this called concept of regenerative organic agriculture, that takes a totally different approach to that we have to give back to the soil, not just the chemicals, which suppress the microbes. I mean, it’s so ironic because these chemical fertilizers actually suppress the microbes, so you have few and few microbes in soil that’s chemically fertilized all the time and plowed. And so, all the things we have done to maximize the output of agriculture has been against this microbial healthcare system that the plants have developed.
Dr. Emeran Mayer:
And so, this nutrient depletion of these plants look beautiful. They’re like on steroids. It’s essentially what we buy in the Whole Food Market is produce on steroids, but to largely be depleted of its natural, most health promoting elements.
Dr. Mark Hyman:
So, it looks good, but it’s kind of not as good for you as it could be, right?
Dr. Emeran Mayer:
Yeah. And you can always tell this, so I look at strawberries, look at the strawberries that as a kid I picked in the forest and that smell. It has such an intense smell and such an intense aroma. Now, you buy these in the supermarket where there are these big strawberries, zero taste and zero smell, so that’s a good example. This applies to everything else as well. I mean, these small efforts of farmers markets in many cities on the coast, which is a movement against it. So, we’ll have to see how successful that is.
Dr. Emeran Mayer:
But yeah, I would say, we have by pushing the limits of what we can produce in terms of plant-based foods. And I should say, the plant-based foods that this system works the best is the food for the animals. It’s not even for us. The system was optimized to grow massive amounts of soybeans and corn but using most of the chemical fertilizer and the most of the glyphosate, that’s the worst thing. That’s destroying the health of the soil and decreases the abundance of diversity of microbes in the soil. So-
Dr. Mark Hyman:
What we’re really talking about is this whole new paradigm of thinking that our health is not just connected to what we do, but what we do to the environment, what we do to the soil, and that the quality of our health is determined by the quality of the food that we’re eating, which is determined by the quality of the soil and the soil health and the microbiome. So, when you talk about Network Medicine, it’s got to include all these aspects that most people don’t even think about.
Dr. Mark Hyman:
And most doctors and scientists are not thinking about farming, and how we grow food and the soil. I mean, they’re just thinking in their little silo, and you’re breaking down all those silos and saying, “Hey, wait a minute. These things are all connected.” And that not only are these polyphenols important for our health in many ways, but they’re critical for the microbiome. And the way we’re growing food is resulting in food that has way fewer of these compounds than ever in history.
Dr. Mark Hyman:
And so, we’re eating even though it looks like a strawberry that looks good, it actually has depleted of a lot of the special molecules that may actually help prevent aging, for example, which is fisetin in strawberries, but it’s not that much in regular strawberries. It’s more in wild strawberries. Really, really powerful paradigm shift.
Dr. Emeran Mayer:
Yeah, you questioned this earlier, “What does the polyphenols do for the microbes and microbial health?” So, there’s been a lot of misunderstanding, as you’re probably familiar with. I mean, the whole enthusiasm about antioxidants, which still dominates the media and the advertising. Yes, if you put a plant-based molecule that is called a polyphenol into a test tube with cells, yes, it has an antioxidant effect. If you put this into a human GI tract less than 5% is being absorbed, because it’s such big molecules, so they travel down the GI tract to our microbiome, which is the end of the small intestine, the large intestine.
Dr. Emeran Mayer:
And then it does several things, one, it’s a prebiotic for many microbes, so it feeds microbes, just like fiber does. Secondly, just like fiber, it’s broken down by microbes into smaller molecules that can be either absorbed or it can work in inhibitory way on unhealthy microbes. So, it has an antimicrobial effect on the bad guys in your gut. It nurtures the good guys, and it has a negative effect. Then how much are these small molecules that these metabolites that the microbes generate are absorbed? How much of that effect is actually mediated by antioxidant effects? We don’t really know today.
Dr. Emeran Mayer:
There’s thousands of these molecules and what they exactly, so we’re doing a big study right now, effects on the brain of flavonoid supplement. And what we read, we have some inklings that they improve cognitive function, and slow cognitive decline. But this is a wide open field of science to understand what this pharmacy that’s created by the microbes does to our health and our brain, just, there’s a lot to found out.
Dr. Mark Hyman:
But it’s sort of fascinating when you think about it, the microbes in the soil help the plants increase their polyphenol content. And the polyphenol content in our foods, they saw these colorful compounds in plant foods, feed our own microbiome. So, it’s this beautiful virtuous cycle, where our own gut are fed…
Dr. Emeran Mayer:
Yeah, it’s interesting.
Dr. Mark Hyman:
… by the beautiful compounds that are made by other bugs in the soil. So, we live in this ecosystem and we ignore it at our peril. I think that’s what we’re finding out and we cannot divorce ourselves from nature or normal principles of Science and Ecology, the laws of Biology. And that, we’ve done that in a way in medicine that has really missed an opportunity to design a way of treating and diagnosing people that creates health as opposed to simply feeds disease. And then goes upstream instead of downstream.
Dr. Mark Hyman:
And your book is so critical in helping us think through some of these issues, The Gut-Immune Connection. I encourage everybody to get a copy. It’s available now. Go to Amazon, your bookstore, wherever. And in that book, you also talk about how you rank your meals based on different nutritional criteria for example. Is there a microbiome Healthy Food Index score, HFI? Tell us about this food index score? How you came up with it and how it can help guide us to choose foods that are going to actually help reset our microbiome and improve our overall health?
Dr. Emeran Mayer:
Yeah, so I came up with this index, I mean, this other index is Healthy Food Index and several people have come up with. But what I really focus on is it’s the ratio of the microbiome-targeted food components, so the polyphenols and the fiber and over or in proportion to the unhealthy things: The sugar. And so, it’s a very simple formula. I’ve also added the omega-3 fatty acids on the denominator, because that’s clearly another we haven’t talk about. It affects the microbial diversity as well, but it’s just a mathematical way of expressing what I said earlier that a microbiome-targeted diet is the best for us.
Dr. Emeran Mayer:
And if you put some typical food items into it. If you put a hamburger and French Fries into it, obviously, you get the minimum value and if you put a vegetarian dish in it, you get the highest value. So, it’s not science, but I think it’s a good way for people to just test it out themselves what they eat, how good is that for their health, and for their microbial health.
Dr. Mark Hyman:
It’s such a great idea, so thank you. Your work is so important and you’re one of the leading scientists in this whole field of microbiome. And I know we’re going to continue to learn more from you. And I encourage people listening to recognize that this is a massive paradigm shift that your doctor is probably not thinking about and not using as a way of treating chronic illness. In my practice in Functional Medicine and many other doctors who do Functional Medicine, we do this every day and we focus on how to rehabilitate and repair the gut and the inner garden. And a lot of the ideas are things that you write about in your book and there are things that people can do on their own.
Dr. Mark Hyman:
And the beautiful thing about this is you can rehabilitate your microbiome without necessarily going to the doctor, just by changing your diet and your lifestyle and some simple, simple things. Now, sometimes you might need a reset, and you need help from a good Functional Medicine doctor, but most the time, we can really take care of this.
Dr. Mark Hyman:
And I can’t wait to see what’s next. I mean, everybody’s got to go out and get the book, The Gut-Immune Connection. It’s really a huge contribution to our understanding of health and the microbiome. And really designing a way of living that actually can really prevent a lot of these chronic illnesses and even treat them. And that’s what’s beautiful about the gut is you can use it as a vehicle to treat so many chronic illnesses. And that’s really what we’ve done in Functional Medicine.
Dr. Mark Hyman:
So, thank you so much for your work, Dr. Mayer. This has been a great conversation. Everybody listening should definitely go out and get the book, The Gut-Immune Connection. It’s available everywhere.
Dr. Mark Hyman:
If you love the podcast, share it with your friends and family. Leave a comment. Tell us how you’ve affected your microbiome through your diet or something else. And subscribe wherever you get your podcasts and we will see you next week on another episode of The Doctor’s Farmacy.
Dr. Mark Hyman:
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 all the experts that I know and I love and that I’ve learned so much from.
Dr. Mark Hyman:
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. 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.
Dr. Mark Hyman:
And all you have to do is go to drhyman.com/picks to sign up, that’s drhyman.com/picks, 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.
Speaker 1:
Hi, everyone. I hope you enjoyed this week’s episode. Just a reminder that this podcast is for educational purposes only. This podcast is not a substitute for professional care by a doctor or other qualified medical professional. This podcast is provided on the understanding that it does not constitute medical or other professional advice or services.
Speaker 1:
If you’re looking for help in your journey, seek out a qualified medical practitioner. If you’re looking for a Functional Medicine practitioner, you can visit ifm.org and search there, find a practitioner database. It’s important that you have someone in your corner who’s trained, who’s a licensed health care practitioner and can help you make changes especially when it comes to your health.
