The Best Foods To Heal The Gut

Mark Hyman, MD

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Announcer: Coming up on this episode of The Doctor's Farmacy. Dr. Mark Hyman: We have massively messed up our guts. We have to really understand the gut is central to our health. How do you hit the reset button on your gut? Dr. Mark Hyman: Hey everybody, it's Dr. Mark Hyman. Welcome to The Doctor's Farmacy, and to a new series on The Doctor's Farmacy called Masterclass, where we dive deep into popular health topics, including inflammation, autoimmune disease, brain health, gut health, sleep, and lots more. And today my friend, my business partner, a podcast host, Dhru Purohit and I are going to be diving deep into part three of our gut health series. Today, we're talking about a critical component of gut healing, which is prebiotics. Prebiotic foods are so essential if you want a healthy gut. So what are they, how do you incorporate them into your diet and how does it all work? That's what we're talking about today. Kick it off, Dhru. Dhru Purohit: All right, Mark. Let's do it. I think we first start off with a little bit of a recap. We've been talking about the gut for the last few weeks in this little mini series that we're doing. And we introduced the idea of a multivitamin for the gut, which incorporates some of these key elements we've been discussing. This is a product that you formulated, that you've been involved with for the last two years and now bringing out to the market, it's called Gut Food. And as a part of that, we dove into the three kind of categories that play a crucial role in Gut Food. We talked about polyphenols, we talked about probiotics and today we're talking about prebiotics, another very central piece of the puzzle and all that together just really rounds out this trifecta of critical gut healing ingredients. Dhru Purohit: So Mark, just to remind us big picture, in case anybody missed the first two Masterclasses, which the links are below, please go back and listen to them after you listen to this, why do we need to pay attention to the gut? And why is it so crucial for all aspects of health, especially longevity, which you're focused on a lot right now? Dr. Mark Hyman: Yeah, listen. This is the century of the gut honestly. The microbiome has taken off as a field of research in the last 20 years, and we've learned so much about the relationship between our gut health and the rest of our health. And it turns out that if your gut isn't healthy, then you're not healthy. If your gut is messed up inside, we call it dysbiosis. It's a huge risk factor for heart attacks, strokes, cancer, obesity, weight gain, diabetes, Alzheimer's, autism, autoimmune disease, allergies, asthma. And of course, all the digestive disorders of irritable bowel and reflux and inflammatory bowel and bloating. I mean, you name it, the microbiome plays a role. Even longevity, in my longevity research it's astounding to see the changes that happen in our microbiome as we age. And the healthiest people as they get older, have healthy microbiomes. The centenarian's poop is much healthier than some young guy's poop who's 60 or 70, who's got all kinds of health conditions. Dr. Mark Hyman: So it's really central. And the question is, why is our gut so messed up and how do we fix it? And the reason our gut's messed up is our processed diet, is a lack of fiber. I mean, we used to eat 150 grams of fiber per person a day. Now, as hunter gathers, now we eat about 8 to 15 and that's why so much constipation exists. And in my book, I talk about Denis Burkitt, who was a British physician who has lived in Africa as a medical missionary. And he noticed this huge difference in the health between the urban city dwellers in Africa and the rural hunters and gatherers who were basically genetically the same. And he noticed that the stool weight of the hunter gatherers was two pounds a day. Dr. Mark Hyman: And that of the urban city dwellers was four ounces, like a little teeny turd. So he didn't know why, he didn't quite understand, but he saw this huge correlation between the size of your poop, correlated with the size of the amount of fiber you're consuming and long term health risks. Elephants have, I think 50 pounds of poop a day or 50 kilos or something crazy like that, because they're eating so much stuff. So we have to learn how to rebuild and reset our guts. And the reason they're messed up is our processed diet, C-sections, lack of breastfeeding, overuse of certain drugs like antibiotics, acid blockers, anti-inflammatories. The glyphosate in our food supply which is on 70% of all crops is a microbiome killer. So there's so many reasons, toxins, pesticides, herbicides. We are just a culture that is gut busting, a society that is gut busting. Dr. Mark Hyman: And so we need to be proactive about maintaining and optimizing our gut health, which is really why we created this product, Gut Food, as a multivitamin for the gut. Nobody's really talked about that. How do we keep our gut healthy? I mean, yes, there's programs and products and treatments for people with severe gut issues. But how does the average person just keep their gut healthy with a low friction opportunity to actually add into things we know are necessary on a daily basis to keep your gut healthy? Probiotics, polyphenols, and prebiotics, which we're going to talk about today. Dhru Purohit: Yeah. We're going to dive all in prebiotics and the thing is much bigger than any kind of product that you're affiliated with or any companies that we work with or anything like that, this is really about education. And education on these topics for low hanging things, diet first. Dr. Mark Hyman: Yeah, of course. Dhru Purohit: I always say it- Dr. Mark Hyman: Of course. Dhru Purohit: Diet first- Dr. Mark Hyman: Of course. Dhru Purohit: That's the first thing that we need to focus on. So on that note, there's a prebiotic food that you're a huge fan of and it's been shown to help out with weight loss, improved metabolism and blood sugar, and that's called resistant starch. What is resistant starch and what are some of the common examples that are available to people out there? Dr. Mark Hyman: Yeah, so resistant starch means that rather than being absorbed by the body, it's not absorbed. It's resistant to absorption. So if it can't get absorbed and you can't use it as calories or fuel, what happens to it? Well, it's eaten by the bugs in your gut. Now, if it's the right kind of starch, called resistant starch, it actually starts to fertilize the good bugs because they start to eat this starch and they grow and the good guys grow. And this seems to have broad implications for improving metabolism, for lowering obesity, lowering insulin resistance, curing diabetes. It's really impressive. And it's in certain types of foods. For example, plantains, green bananas, lentils, Dhru, some artichokes. There's a whole bunch of these have resistant starch that can be taken and eaten on a regular basis that will help actually create a better gut environment. So it's a really beautiful way to eat and actually not get the calories, get the taste and have your gut be really healthy and happy at the end of it. Dhru Purohit: So Mark, you just listed a bunch of them. What are a couple of your favorites and how are you incorporating them into your diet on a regular basis? Dr. Mark Hyman: Well plantains are great, I love those. You can stir fry them, cook them. You can put them in smoothies. Lentils are great, you can make lentil soup. Those are really great resistant starches. Dhru Purohit: And just to interject really quickly on the plantain side, plantains definitely have like less total sugars compared to like bananas and stuff. But being the blood sugar guy, people are always asking, you're like, okay, you're saying this thing is good for being a resistant starch and how do I be mindful about incorporating in my diet if I'm trying to also be mindful of it. Dr. Mark Hyman: Yeah, but resistant starches also tend to help with insulin resistance and insulin sensitivity. So they're not having these big spikes. And they're actually being consumed, not by you, but by the bacteria. And they produce something called short chain fatty acids, which are incredibly important as fuel for the gut cells, as regulators of signals of cancer risk and are so important for your overall health. And that's what's so beautiful about prebiotics is that they help grow the right bacteria, which are producing in these shorting fatty acids, including butyrate that are so protective against a whole host of diseases. Dhru Purohit: Yeah. And also, I understand that green bananas are also in that category. Dr. Mark Hyman: Yeah, green bananas. Dhru Purohit: They're green, that means that they are like- Dr. Mark Hyman: Unripe bananas. Dhru Purohit: Unripe and there's less sugar content that's there. Dr. Mark Hyman: Yeah. But they don't taste that good. Dhru Purohit: They don't taste that good. Dr. Mark Hyman: But you could kind of figure out how to make them, you could cook them. Dhru Purohit: There's powders that are out there as well. Dr. Mark Hyman: Yeah. Dhru Purohit: Are you a fan of those? Dr. Mark Hyman: There's powders. You can take potatoes, little tiny potatoes that are like the Peruvian potatoes that are already lower in starch and sugar. You can cook them and cool them and then you can eat them that way in like a potato salad. Those are more resistant starches. So there's a lot of ways to sort of make resistant starch. But I think the naturally occurring ones are the best, like lentils and plantains and green bananas. Dhru Purohit: Sure. And following a bunch of tips like the Glucose Goddess who was recently on your podcast, was talking about putting clothes on your carbs, adding a little bit of fat, having them with a bunch of fiber. Dr. Mark Hyman: Fiber, yeah. Fiber, yeah. Dhru Purohit: Those are things that are going to be helping and actually get the benefits without the blood sugar impact. Dr. Mark Hyman: So funny. I just did a talk at a university called Queens University in Charlotte, South Carolina. And this woman was interviewing me who was like a top chef and she was really great. She was a chef and she has to do a tasting contest of desserts. So she's freaking out that she's going to gain weight because she has to eat all these desserts for the next month. And I said, "Well, all you have to do is take something called PGX, which is PolyGlycoplex, basically made from konjac root, which is a very highly viscous fiber that absorbs 50 times its weight in water." So I said, "Just take that about 15 minutes before you eat dessert, it won't spike your blood sugar. You'll be fine." Dhru Purohit: Yeah. PGX is a great product. Shout out to the company, Natural Factors I think is- Dr. Mark Hyman: That's right. Natural Factors. Really great. Dhru Purohit: That's a great product. Dr. Mark Hyman: It's kind of a hack. You take that before you eat and you do much better. Dhru Purohit: Yes. Although, it's tough to drink a big glass of water with it. Dr. Mark Hyman: You get used to it. Dhru Purohit: You got to make sure you drink like- Dr. Mark Hyman: Two glasses. Dhru Purohit: At least two glasses of water. Dr. Mark Hyman: Yeah, yeah, yeah, you mix it. Dhru Purohit: If you're going to take it. So can you talk a little bit about the compounds that are produced when our gut bugs eat prebiotics? Why are these so critical for our overall health? Dr. Mark Hyman: Well, these compounds I mentioned are short chain fatty acids, and that's a big mouthful. But these are the products that are produced by bacteria when they're digesting the right fibers and including prebiotic fibers. And yes, we talked about resistant starch, but there are also lots of other foods that just have prebiotic fibers in them and the gut bacteria love these. Like legumes, beans, dandelion greens, garlic, artichokes, asparagus, onions, konjac root, which is what I was talking about, the PGX, cocoa actually, flax seeds, jicama, seaweed and polyphenol rich foods. These are all prebiotic foods. So we need include these in our diets. So when I go to the grocery, I'm going to get asparagus and artichokes and onions because I know these are prebiotic foods that are going to help my microbiome. I think about it. Dr. Mark Hyman: Or I'm going to buy jicama and put in my salad because it's a prebiotic food and I want to actually increase the food for my good bugs. So I'm shopping, thinking about this all the time. And the reason they're important is they produce these compounds, short chain fatty acids, butyrate is one of the most important ones. And we know that butyrate is not just for providing fuel for the colonic cells to keep them intact and everything working. But it's actually also a cancer regulator, an inflammation regulator. It regulates risk of heart disease and cancer and diabetes. So it has so many benefits. It's one of the most important molecules in the body, butyrate. And we don't have enough of this. And I test my patient's stool all the time and I see so many people are just so low in butyrate. And it really is necessary because it's necessary to keep your metabolism up, to reduce inflammation, to prevent cancer and to help heal a leaky gut and prevent a leaky gut. Dr. Mark Hyman: So when you, for example, have low butyrate levels, you can't maintain the integrity of your gut lining that causes leaky gut, you get food allergies, food sensitivities, you get leakage of bacteria, you get systemic inflammation. That leads to more weight gain, more inflammation, more heart disease, more cancer, more dementia, more depression. I could just go on and on. So basically, when you have prebiotic foods, it helps the gut bugs flourish and then they can replicate, they produce our vitamins like vitamin K and biotin. They regulate your hormones and they basically remove toxins. But when you don't have these good bugs, you're kind of screwed. Dhru Purohit: Well, one of the prebiotics that's in your formula that you put together, Gut Food, is acacia fiber. Talk to us a little bit about that and why it was one of the things that you were using when your gut was messed up and you were dealing with a lot of leaky gut, which had a whole host of challenges. Dr. Mark Hyman: Yeah, for sure. So acacia fiber is a really wonderful prebiotic fiber. It's well tolerated, often more than other fibers cause they can be hard of the system. It makes you feel full. It helps control blood sugar and cholesterol. It's an antioxidant and it helps really help correct a leaky gut. And what's really quite amazing about acacia fibers is it's actually been studied to lower a whole set of cytokines, basically through lowering something called NF-κB. NF-κB is what we call a transcription factor. It's a compound that the body makes to tell your genes that there's a problem and to make more inflammatory molecules called cytokines. And then you get all these cytokines produced like TNF alpha and interleukin 6 and interleukin 8, which are very inflammatory. And you get kind of all these problems when you have inflammation. Dr. Mark Hyman: So when you actually have acacia fiber, it lowers the NF-κB it lowers, IL-6, it lowers the TNF alpha, these dangerous cytokines and it actually increases the anti-inflammatory cytokines like interleukin 10. So you've got a brake and you got an accelerator on your immune system. So you don't want the accelerator going all the time, you don't want the break going all the time. So we have just so much in our culture, in our life, in our environment, our diet, our toxic load that drives inflammation. And so if you're not getting compounds that help to lower that, you're actually accelerating aging and obesity and all the chronic illnesses. So it's super important to make sure your cytokines are balanced and that's really key. And that means making sure you have enough of the prebiotic foods that produce the short chain fats and take care of it. And the acacia fiber is another one of the essential fibers that's so key. Dhru Purohit: I love it. There's another prebiotic that's also included in the formula that I'd love to have you talk about galactooligosaccharides. It's a mouthful. Dr. Mark Hyman: GOS. Dhru Purohit: GOS, as often referred to. What are the benefits and some of the research show about GOS? Dr. Mark Hyman: Well it's quite amazing. I've taken this product quite a while and it's a powerful product because it is so good at feeding the good guys and in 14 days, and bloating is a huge problem for people. Like the food baby thing is a real thing. I promise you. My patients send me pictures of it all the time, "Look at my food baby." But 71% reduction in bloating at 14 days. A 92% reduction in pain, a 71% reduction in flatulence or gas. That's a big deal. Dr. Mark Hyman: And these are really debilitating symptoms for people. And what's also interesting is that it doesn't just affect the bloating gas and digestive symptoms, but it has indirectly effects on the immune system. So you see almost a 60% increase in phagocytosis, which means your macrophages, which are little Pac-man that go around and clean up all the problems and viruses infections are increased in function. And natural killer cells, which are really critical for fighting infections and viruses and cancer, there was 106% increase in natural killer cell function in 10 weeks. That's impressive. And so that's what helps you fight viruses and cancer. And there was also a higher level of interleukin 10, which is one of the anti-inflammatory cytokines. It's all from taking a prebiotic. This is how powerful they are. Dhru Purohit: Okay, Mark, switching to the next part of this discussion. So typically when people think of the gut, they think probiotics, but what we're seeing is that prebiotics are just as important, especially for creating these beneficial compounds that improve digestion and help prevent even chronic diseases that are out there, top ones that we all know about. Ideally, this means eating a high fiber diet. So let's break down a typical plate of food for you. How much fiber and prebiotics are in that plate of food and how much fermented food and how much protein and how much fat? Just describe your typical meal. Dr. Mark Hyman: Yeah, sure. I think it's important to understand that probiotics are like the seeds you put in the garden. Prebiotics are like the compost you put on the ground to make the seeds grow. It's really important to think of them together. And the polyphenols are like super fuel on all that stuff. It's a trifecta of a powerful set of compounds that really have never been put together in a product before. And that's really why we created Gut Food. And when you look at particularly my particular day, I tend to eat a lot of fiber rich foods. And I love those foods because I just like them. But it includes a lot of veggies. So tons of raw veggies and salads, cooked veggies. Dhru Purohit: Cooked onions. We learned last time, we can't have raw onions. Dr. Mark Hyman: Cooked onions. And I do. For example, the other night, as a meal, I had duck breast. I had Shiitake mushrooms, which are also very high in certain compounds, like polysaccharides that are helpful for immune function. I had artichokes, I had steamed artichokes, which have again, prebiotic fibers and also folate and detoxification compounds. I had, I think a Japanese sweet potato, which again is full of fiber and also phytochemicals and polyphenols. And also, I had asparagus. I had stir fried asparagus with ginger. So I'm providing all the spices and the asparagus, which also is a prebiotic food into my diet as just a natural part of cooking and what I like to eat. So I've learned to include some core foods in my diet on a regular basis that I know are both probiotic foods and probiotic foods, and also fermented foods. Dr. Mark Hyman: I have miso, I have kimchi, I have sauerkraut. I like pickles, being a good Jew. So basically, I eat a lot of these foods and then, and then I'll make sure I eat, those are probiotic foods, and I'll eat the prebiotic foods like I mentioned, and the polyphenols. So I tend to eat a lot of colorful fruits and vegetables. And then as fats go, I tend to stay away from refined oils. Avocados are great, nuts and seeds are great. Extra virgin olive oil's great. So I tend to stick to those fats. And protein is just your palm size serving of protein. If you're three years old or you're 50 years old, whatever your size your palm is, that's about the protein needs you have per meal. And that can be plant proteins or animal proteins, but plant proteins, you typically need to eat a lot more to get the same grams of protein. Dhru Purohit: If there was one prebiotic food, to people that are listening today, somebody's like, "You know what? I'm not eating any of the prebiotic foods." There's one that could be a great starting place, maybe a little easier on the pallet, but still beneficial to them, what's that one prebiotic food that if they're not including today, they should think about incorporating? Dr. Mark Hyman: Well, it's kind of a fun one. And it sounds counterintuitive, but it's noodles. And not just any noodles, but a special kind of noodles called Shirataki noodles. And these noodles are Japanese noodles that are made from konjac root. This fiber I talked about that was in PGX. It's a prebiotic food, but also has tremendous power to slowly absorb glucose and fatty acids and other things that actually drive weight gain, obesity. And you can enjoy them because they have no calories and they have no carbohydrates. It's just fiber. So you can make pasta with them. You can put them in soup, they're delicious. And you can buy them now, pretty much everywhere, you can buy them online. Dhru Purohit: They're called miracle noodles. Dr. Mark Hyman: Miracle noodles. Yeah, Shirataki noodles. They have weird ones that are made from soy, but get the ones that are made from konjac route that's konjac not conjac like the drink. And that's kind of a fun one. Dhru Purohit: We make stir fry at our place all the time. By the way, we have no affiliation with this company. It's just something nice that people like to incorporate. Dr. Mark Hyman: Exactly. Dhru Purohit: It's a good way to get you off a lot of that refined carbohydrates, if you're eating pasta on a regular basis. Nothing wrong with enjoying some pasta here and there. We had some pasta last night, as a special treat. We went to a friend's restaurant. Dr. Mark Hyman: Heirloom grains. Dhru Purohit: Heirloom grains and they're bringing in from Europe and other stuff. But that's not how we eat on a typical basis. So miracle noodles are a nice way to mix it up and get some of that texture that people enjoy from noodles and pasta, but not have it be so detrimental to your metabolic health. Dr. Mark Hyman: Absolutely. And then I think if you really want to get into it, you can have more artichokes and plantains. Dhru Purohit: How easy is it to cook artichokes. They can look intimidating for people. Dr. Mark Hyman: Oh my God, artichoke is the easiest thing in the world. You basically steam it for an hour and you have to make sure enough water in the pan or boil it and then take it out. And I just dip it in olive oil and vinegar. Dhru Purohit: That's it. You don't do oven, you do steam it. Dr. Mark Hyman: I just steam it. It's usually been an hour, depending on the size of the artichoke. Dhru Purohit: Little pot and a bamboo steamer, do you use? Dr. Mark Hyman: No. I have like a pasta pot, which I don't really use for pasta anymore. But I fill the bottom up with water and it's got a metal strainer in it. I put them in there. You can also boil them too. You can just boil them, that's fine. I like to steam them. But yeah. And then when they're soft and the leaves pull off easily, take it out after about an hour. It takes a while to eat. You have to dip the leaves in the olive oil and vinegar and you scrape off the yummy parts with your teeth. Dhru Purohit: It taste great. And if you're not used to eating them on a regular basis, maybe start off small initially, and then you can slowly work your way up. Dr. Mark Hyman: You don't want to eat the hairy parts in the middle. You have to get to the heart of the artichoke and you have to take off the hairy bits in the middle. But it's fun. It's an adventure. Dhru Purohit: It's an adventure for sure. So Mark, as part of this mini series, we haven't gotten to many community questions. But we'll toss in some community questions here. And these are from your audience, your Dr. Hyman+ audience, your Instagram audience, your podcast audience. So let's jump right in. So first question, can you take pre and probiotics at the same time? Dr. Mark Hyman: Absolutely. You want to because you want to fertilize the bacteria. So you want to fertilize the bacteria in your gut that are already there, but also if you want to help grow a little bit more of the actual ones you're giving. So it's certainly fine to take them at the same time. The one caveat is you're taking prebiotics and probiotics and you have bacterial over growth or fungal over growth in your gut, it can create a war and you can often feel a lot worse. Dhru Purohit: And what's an example of that happening, or taking place? Dr. Mark Hyman: If you start taking probiotics and all of a sudden you feel like you had somebody come with a tire pump and pump up your intestines and you're bloated and distended, and it's painful, that's a clue that maybe there's something rotten in Denmark and you need to go figure out what's going on in your gut that needs weeding. Is it a bacterial over growth, fungal over growth, a parasite? Then you can kind of make a more coherent stand on what actually is working or not. Dhru Purohit: And often one way different companies will do this is you're taking a prebiotic, it's something new to you, or you're taking a probiotic, you start small and you build your dose up so your body can get used to it. Yes. And I think that's even in your recommendations around Gut Food, as you start titrating. Dr. Mark Hyman: For sure. Start slow and build up. Dhru Purohit: Slow. Yeah, exactly. And I think there's instructions on how to do that. What are your thoughts about jicama and is it one of the best probiotics that are out there? Dr. Mark Hyman: Jicama is a great probiotics. So if you don't know what jicama is, it's like a, I think a Mexican, kind of- Dhru Purohit: South American. Dr. Mark Hyman: South Americany kind of vegetable that is like a big white root or something. And you basically peel it and you cut into thin little matchstick slices and you throw it in your salad. I love putting it in my salad. It's crunchy. It's kind of got a nice taste to it and it's great prebiotic. So it's a go-to for sparking up your salad with a prebiotic fiber. Dhru Purohit: And it's been really interesting to see a lot of companies start to incorporate jicama on their products. Your friend, Mona, my friend, Mona, they have their product Xicama, spelled with an X. We'll link to the show notes. It's a nice beverage mixer that people can use just by itself or solo. And then our buddy, Junaid, and we invest in his companies, Farmers Juice. One of the ways green juices spike people's blood sugar so much because they have so much fruit juice inside of them. And he used jicama to improve the taste, but not spike people's blood sugar. And I'm so excited about all those companies. Those are two of them and there's plenty of others that are out there that are using jicama juice in their products. So if your diet is in check and pretty pristine, do you still need to supplement with prebiotics and probiotics? Dr. Mark Hyman: Not necessarily. If you're eating 100 grams of fiber a day, and good luck, let me see that and you're eating the right prebiotic foods and you're really doing the right things by your gut in terms of your overall diet, I think it's not necessary to take prebiotics. But for most of us out there, our guts are pretty messed up and we need a daily dose of something to help. Now, if we're not going to be eating at... I'm traveling right now. So I can't always control what I'm getting. I try my best. We had seaweed salad for lunch, cause I know that's got prebiotic fibers in it. That helps me. But I do like to have the insurance of having something on a daily basis, knowing that there's so many things that disrupt our gut and it's just a good insurance policy to get a multivitamin from my gut every day. Dhru Purohit: Mark, I'd love to get your thoughts on this. That study around the 150 grams, 100 grams of fiber. There's a gentleman named Justin Sonnenberg. I believe he's from Stanford University. And he was one of the ones that was looking at one of the tribes in Africa and looking at their diet, the hunter-gatherer tribes that are out there. Dr. Mark Hyman: The Hadza. Dhru Purohit: Hadza, exactly. And in that paper, a little bit of the controversy that's been there online is that some people are more of like, I guess we call like the carnivore community. They talk about how a lot of these hunter gathered tribes, fiber was more of a fallback food. Now, Justin recently an interview that he did with Andrew Huberman, who's also been on your podcast and we'll link to in the show notes, he was saying that, yes, it's a fallback food. If they would prefer honey all day, they would prefer to eat honey all day, but they just can't get a honey all day. They would prefer meat all day but hunting is a little bit tough and not always are animals there. So whether it was done by design or by default, he's saying they're still having this amount of fiber in their diet. Dr. Mark Hyman: yeah, of course. Dhru Purohit: They have the same food addictions that we have. Dr. Mark Hyman: Of course. Dhru Purohit: If you could give them processed food all day, they would choose processed food all day. It's not like they have some enlightened idea around food. And just any thoughts on that big picture? Any extrapolation you want to add in because some people would say, "Well, when they can get access to meat and honey, they would choose and they would prefer that. So since we have meat and honey are all around us, why do we need to be having things like fiber as a regular part of our diet?" It's just one of the arguments that's out there. Dr. Mark Hyman: I mean, listen, if you're at carnivore, your gut microbiome changes very fast. If you're an omnivore, it's different. If you're a vegan, it's different. So what is the right microbiome? That's really the question is how do you get a healthier microbiome? And I think we still haven't figured that out. We know we can measure diversity, which is important, the complexity of the ecosystem. We can measure markers like short chain fatty acids, inflammatory markers. We can look at what bugs are there, what are not there what's growing, if there's parasites. All that is helpful. What I find challenging about some of these microbiome tests is they only look at the microbes, they don't look at the function of the gut. And as a functional medicine doctor, that's what I care about, is what are these bacteria doing? Dr. Mark Hyman: For example, some kids who I'll see who have autism very, very low short chain, fatty acids of for example, butyrate, which is anti-inflammatory and very high levels of something called propionic acid, which is very inflammatory. And propionic acid has been shown in animal studies to increase autism and autism behavior. And if you look at breastfed kids versus bottle fed kids, they have different short chain fatty acids. The breastfed kids have high butyrate because their bacteria are being fed by the breast milk with the oligosaccharides that are in the breast milk. Basically, the oligosaccharides are a prebiotic, right? This is a prebiotic made by the body for the bacteria, have four babies in breast milk. That's what it is. And if you take formula, there's no prebiotic oligosaccharides. And so instead of getting butyrate, these kids get high propionic acid. And that's why we see breastfeeding is so important correlated with better health outcomes and where maybe bottle feeding is leading to increases in propionic acid, which can have adverse consequences for cognitive function, for autism and learning difficulties, ADD, and lots more. Dr. Mark Hyman: So I think it's important to realize that our diet really matters and that the prebiotics that are in our food really are key. And so historically, if we were hunter-gatherers, we didn't have a choice. We had to eat whatever we could. We got root, a berry, some tree bark or whatever. And that's just what we had to do. And that was more of a natural environment for them. Yes, if all we had was sugar, that's all we'd want to eat, we'd be really happy, but we'd get very sick. But they had a wide variety of foods and a far more complex diet than we do. The whole variety of roots and berries and plant foods and lots of different kinds of animals. And also, they'll eat the bone marrow, they'll eat all sorts of stuff. So really, really important to think about how do we get the right balance of things for us in a way that isn't going to be too onerous, but that it's going to be designed to fertilize the right bugs and not grow the wrong bugs. Dhru Purohit: So another question we have from the community, is a prebiotic good for people who have IBS? What are some of the considerations that people who have IBS have to think about? Dr. Mark Hyman: Yeah. So generally, when I think about someone with a gut issue is the weeding, seeding and feeding program. And I think the IBS group can be constipation, can be the diarrhea. But typically, there's a component of bacterial overgrowth or fungal overgrowth. So I really am very careful about when I'm working with these patients, not overdo stuff too fast with the pre and probiotics. I usually give them a week or two of weeding, clearing out the bad bugs with herbs, medications, antifungals. And then we see if the body can be able to tolerate these things, there's not a war going on. Dhru Purohit: All right, next question from the community. What's the difference in digestive enzymes and how are digestive enzymes different than pro and prebiotics? Dr. Mark Hyman: Well, Dhru, in order to have a healthy functioning gut, you need a lot of things going on. You need to be able to digest your food, you need the right stomach acid, you need digestive enzymes from your pancreas, you need salivary enzymes from your mouth. You need the right fibers and prebiotics to actually help grow the right bacteria. You need probiotics, you need postbiotics. You need all the things you need to actually keep a gut healthy. Dr. Mark Hyman: And so when we're thinking about repairing and fixing the gut, we need to think about all those things. And I see people with low pancreatic function, low hydrochloric acid. And so sometimes giving them supplements with pancreatic enzymes or more plant-based digestive enzymes along with hydrochloric acid can actually be very helpful. So it's really depending on the person, but if people have a lot of SIBO and bacterial overgrowth and digestive upset and undigested food in their stool or on their lab test, we see low pancreatic elastase, we can actually help to treat them in an effective way by providing those enzymes for people. So it's not either, or, it's a select group that might need them, but when you need them, it can be really helpful. And then when you get your gut healthy, you don't need them so much anymore. Dhru Purohit: Now, sometimes when people are going out to restaurants or they're eating foods like gluten and dairy, which people partake in every so often, it's a part of metabolic flexibility. Some of my friends might take digestive enzymes with them to the restaurant or whatever. Do you ever do that? Dr. Mark Hyman: Yeah, there's actually gluten digest enzymes. There's lactase enzymes. There's things that help with dairy and so forth. So you can use them to sort of mitigate problems that you might have if you go out and cheat a little bit, but depends on who you are. If you're a celiac, you don't want to cheat at all. If you're having severe dairy reactions, you don't want to cheat at all. But for some of us who just may have a little upset tummy or whatever, I think it's fine. I think the goal is ultimately to eat in a way that actually's going to rebuild your gut so you're more resilient. That's the whole game here in functional medicine. It's not restriction, but freedom. And metabolic degrees are freedom by optimizing your body's systems. And once you do that, like I said before, I couldn't do anything for years without being sick, without causing rashes over my body, my eyes getting red, my tongue getting sores, my stomach bloating, having severe brain fog, fatigue. Dr. Mark Hyman: It was so immediate. And I knew exactly what was going on. At the time, this was almost 30 years ago. I didn't know all that I know now, where microbiome wasn't even a word. We knew how to work with the gut, but it was really tough and it was hard to reset the system. And for me, it was challenging because I had mercury poisoning. And if you have something like that, you can do everything you want. You can take all the prebiotics, polyphenols, everything you want. Unless you get rid of that, you're not going to get better. Dhru Purohit: So Mark, I think this is a perfect opportunity to do a little bit of a recap. We've been doing this multi-part series and we've just covered polyphenols to start and we covered probiotics and then we covered prebiotics all under this greater umbrella of we live in a world that has never been more destructive to our gut. So we want to be more mindful to take care of our gut because health and disease starts in the gut. So give us a little bit of recap of some of the top points that we learned through this multi-part series. And we'll have more to come soon, but at least so far, where are we at? Dr. Mark Hyman: I think the first high level is we have to understand as a culture, we have massively messed up our guts by our industrial processed diet, our lack of fiber, our lack of phytochemicals and polyphenols, by the increasing C-section rates, lack of breastfeeding, the use of antibiotics and gut busting drugs like Advil and Aspirin. So it creates a perfect storm for a disaster of a gut environment that promotes all sorts of downstream problems from not just digestive issues, which are the number one reason people visit the doctor, but all sorts of chronic diseases, from heart disease to obesity, to cancer, to diabetes, to dementia, to autoimmune diseases, to allergies, to asthma, to autism to ADD. I mean I could go on and on. So we have to really understand that gut is central to our health, every aspect of our health. Dr. Mark Hyman: And so we really have come up with a framework for helping people to reboot their gut. How do you hit the reset button on your gut? Well, it involves diet. So upgrading your diet and the quality of the food you're eating, increasing the fiber content, polyphenol content, phytochemicals, super important. Second, we need to supplement with the right things like a multivitamin for our gut, with the right prebiotics, the right probiotics and the right polyphenols to help. So for example, in our product, Gut Food, we have a lactospore probiotic, which is a spore based probiotic. Very well researched. We have galactooligosaccharides, which are incredible prebiotic food. Acacia fibers are probiotic. We have something called Mucosave, which is prickly pear and also olive leaf extract, along with quercetin, which are incredible polyphenols for helping boost the good bacteria in the gut. Dr. Mark Hyman: For example, Akkermansia muciniphila is highly responsive to these. It's exactly what it sounds like. Muciniphila means it's mucin loving. So it creates a mucus layer in the gut to prevent a leaky gut. So we have all these ingredients that are designed scientifically to optimize the gut environment, to be like a multivitamin for the gut and to help people really create a baseline that they can rely on. It's like, why do you need a multivitamin? Well, because we're not eating 800 different food crops anymore. And a lot of our food's depleted and we've had all these problems. So in a perfect world, we should not need all these things, right? Dr. Mark Hyman: And I always say, you don't need a vitamin, but only in a certain conditions, right? You only hunt and gather your own wild food. You only drink pure clean water, breathe pure clean air, have no environmental exposures, have no chronic stress, sleep eight to nine hours a night and exercise all the time. Now, if that's you, no, you don't need a multivitamin. But everybody else, yes. So the same thing with a gut multivitamin. In a perfect world, you wouldn't need this. Maybe if you're a Hadza living in the jungle and you're eating in Africa, all the wild stuff and you're doing your thing, no, they probably don't need all this stuff. But for the rest of us in modern society, absolutely. Dhru Purohit: I love it, Mark. Thank you for taking us through all that and more. Let's go ahead and conclude today's episode on the topic of prebiotics. Dr. Mark Hyman: Well, thanks so much Dhru for doing this Masterclass with me and doing it on the gut, which is my favorite topic. As I said, they like to call me Dr. See Every Poop. And if you want to learn what I've learned and you want to take advantage of what we've been doing for 30 years in functional medicine, have a look at our new multivitamin for the gut. It's called Gut Food. Just go to GutFood.com to learn more, sign up for the wait list, when it's coming out. Share your stories with us about what's worked for you for your gut and health and how you optimize your gut function. If you love this episode, share with your friends and family on social media. Subscribe wherever you get your podcasts and we'll see you next week on The Doctor's Farmacy. Announcer: Hi everyone. I hope you enjoyed this week's episode. Just a reminder that this podcast is for educational purposes only. 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