Abstract
Drawing on both personal experience and clinical evidence, Vincent Pedre, MD, shares his insights about how a healthy gastrointestinal (GI) system can serve as a foundation for improving patients' overall health. Author of the book Happy Gut: The Cleansing Program to Help You Lose Weight, Gain Energy, and Eliminate Pain, Pedre has created a unique action plan for repairing and restoring GI health and preventing disease.
I grew up in a Cuban household and was definitely consuming a lot of pastries, bread, and dairy products. When I attended college, I continued eating a similar diet as that of my childhood. However, by accident, when I attended medical school, I stopped drinking as much milk because it did not fit into my lifestyle. As a result of this, I observed that I was experiencing fewer respiratory infections. That observation was the beginning of a correlation that perhaps my diet was linked to my immune system. By then, I was also very interested in alternative medicine and read books by Deepak Chopra [MD] and Andrew Weil [MD], and this reinforced my interest in experimenting with my diet.
I also grew up in a household that was part of the low-fat craze of the 1980s, when fat was demonized. I was overweight as a child, but lost weight during my teenage years and was obsessed with avoiding fat. In medical school, however, I changed that stance and started eating healthy fats, such as avocado and olive oil. When I removed dairy from my diet and added the healthy fats, I felt the best that I had in more than a decade. These events just continued my interest in the role of diet and health.
While studying functional medicine, I realized that it was not just dairy products that were irritants for my GI tract, but also gluten played a role. I started investigating specific foods that were causing reactivity and went on a complete elimination diet. I conducted this in a scientific fashion, because, even though I knew that wheat was an issue for me, I needed to see results through food sensitivity testing to convince myself that I had to make what seemed like a big sacrifice at the time—removing gluten from my diet. I also looked upon it as a challenge and wanted to be an example for my patients who were making similar changes in their diets. At the end of 4 weeks of following an elimination diet, I felt so great that I continued for 6 months longer before I reintroduced certain foods. At 6 months, after reintroducing wheat into my diet, I immediately developed a skin reaction. Slowly, I brought back some foods that I was not as reactive to and continued on a gluten-free diet. Now I am a seasonal dairy eater, eating cheese only during the summer months when I am not worrying about viral infections or seasonal allergies, which, by the way, disappeared on my new diet. Of course, there is a lot of biochemistry that is happening in the background of this story.
My medical training was very evidence-based, and it seemed as if every solution was centered on pharmaceuticals, and I thought: “This is not the only way to practice medicine.” Through my personal experimentation, I saw the power of working with dietary interventions to improve health. Now we have solid research about the microbiome and its role in gut health, and also the health of the immune system, and the gut–brain connection. We are in an amazing transformative time in medicine, because research is finally catching up with what alternative circles have realized for decades.
Obviously, careful attention to diet needs to occur with any person that presents with gut-related symptoms such as bloating, indigestion, heartburn, reflux, constipation, and/or diarrhea. Then clinicians should think about the gut when someone is presenting with hives, eczema, or even seborrheic dermatitis or rosacea. Clinicians should also think about gut health in patients who are presenting with fatigue, fibromyalgia, or body aches. These patients always need a gut-centered approach, and it should be the foundation of anything we pursue with them.
What is even broader than what I have just mentioned, clinicians have to think of the GI system when it comes to autoimmune disease. Researchers are making connections between certain gut bacteria and autoimmune conditions such as rheumatoid arthritis and multiple sclerosis. We also consider GI health in the treatment of people with Lyme disease, not only because they will likely be on longstanding antibiotics that are going to wipe out their GI flora, but also because many of these patients, as a consequence of their condition, have disordered digestive systems.
Brain issues, mental fog, depression, and attention-deficit disorder may all be connected to the gut and the diet. I have also seen a remarkable turnaround in how a person feels by removing a food that was causing inflammation in the body and was felt by that person as chronic anxiety. So, the reach for when to consider GI health in our patients is very broad. In my view, it all comes back to the diet and GI health and the connection with inflammation—the slow, smoldering fire that starts in the gut, but then spreads throughout the body.
We know that butyrate is the favored energy source for the colonocytes, the cells that line the colon, but butyrate also gets absorbed. It passes the GI barrier and goes into the brain, and what researchers have found is that butyrate actually has an epigenetic effect and turns on gene expression of brain-derived neurotrophic factor, which increases brain plasticity and long-term memory. 4 So this is an amazing example of the loop between what we eat, the type of bacteria living in the GI tract and brain health. For me, this is one of the most remarkable gut–brain connections I have learned about.
Another part of the Cleanse equation is to eat mostly plants, and ideally, if one's wallet allows, to buy organic products. Part of the Cleanse program is also about avoiding foods that have obvious toxins such as pesticide residues. Also, if a person eats meat then I recommend choosing hormone-free, grass-fed, and ideally, pasture-raised animals and also choosing wild-caught, cold-water fish.
I encourage patients to consume healthy fats in the diet, such as olive oil, coconut oil, and avocado. If people are not allergic to nuts, then they may add nuts as well as seeds. It sounds a bit like the Mediterranean diet, which has a lot of research behind it. Research suggests, however, that people from the Mediterranean who follow such a diet also benefit from the healthy lifestyle that accompanies living in the Mediterranean, which explains their longevity.
Cooking on nontoxic surfaces is another consideration in the Cleanse part of the program. Fire retardants used on nonstick cookware and utensils enter into the food and into the body, and these are persistent organic pollutants. People should think about cooking on stainless steel or porcelain-enameled cookware that is not going to leach toxic substances.
When cleansing, one must also think about drinking clean water, which is an issue that has been increasingly in the news. A couple of years ago in Washington, D.C., women were having miscarriages at a higher rate than expected, and this was linked to lead exposure from drinking water coming through old lead pipes. So, these are all things that need to be considered.
Finally, regarding Cleanse, clinicians should think about internal toxicity in their patients, such as chronic stress and negative thinking, which affect the mind and body. I talk with my patients about expressing gratitude as a way to cleanse away negative thoughts and also to promote positive thoughts of wellness.
The second part of the program is Activate, which is about reactivating the health of the GI system. This is when I consider using supplements such as digestive enzymes to help support digestion. I recommend starting with the broad-spectrum digestive enzymes with patients who are presenting with gut issues. When considering if a person needs digestive enzymes, clinicians can learn a lot just by taking a history and without doing testing. For example, if a person has partially digested or undigested food particles in the stool, then that patient may not be producing enough digestive enzymes. If the patient is experiencing loose stools when eating fatty meals, that patient might not be making enough lipase and might have pancreatic insufficiency. If a person has difficulty eating protein, or when eating meat, it sits heavy in the stomach, it might be caused by insufficient stomach acid (hypochlorhydria).
I also receive referrals of patients who were placed on proton pump inhibitors by other doctors, and I need to reeducate these patients about acid reflux. I help them to understand that their acid reflux could be the complete opposite of what they think, and they may actually be suffering from a lack of stomach acid. If a person is not making enough stomach acid, then the food sits there for too long. So, these are some of the things to consider in the Activate part of the program to improve digestion and nutrient absorption.
The next step is Restore, which is all about reestablishing the gut flora. Gut flora may have become unbalanced through infections, antibiotic use, or yeast overgrowth, for example. A healthy gut microbiome may be restored by eating foods rich in prebiotic fibers or cultured foods rich in probiotic bacteria. Prebiotic foods include raw chicory root, raw Jerusalem artichoke, raw garlic, and asparagus, and probiotic foods or cultured foods include yogurt and kefir, cultured beverages such as Kombucha, as well as fermented vegetables, such as sauerkraut or kimchi.
When it comes to prebiotic supplements, one may prescribe inulin powder, but clinicians should be careful because too much of a good thing can be a bad thing. If the amount of the prebiotic is increased too quickly, patients may develop a lot of flatulence and feel bloated. In terms of probiotic supplements, I consider broad-spectrum probiotics with several species of Lactobacillus and several species of Bifidobacterium as a starting point. However, if putting someone on a probiotic makes that person worse and they become bloated and gassy, then clinicians have to consider that this person may have underlying small-intestine bacterial overgrowth [SIBO] and might need to test for that. SIBO requires a whole-system approach to cure it. It is not simply about just treating the patient with “magic-bullet” antibiotics and hoping for the best. Clinicians have to approach these patients in a comprehensive fashion, which may include antibiotics and antifungal herbs, a low-FODMAP* diet plan, and post-treatment antimicrobial herbs to prevent regrowth.
The last part of the program is Enhance, and this step is about healing the GI tract by using nutrients that have been studied and shown to help heal and reintegrate the gut lining. When we talk about leaky gut and the role of zonulin in gut permeability, we see that nutrients such as
That is a very brief summary of the elements of my GUT C.A.R.E. Program, which I discuss in further detail in my book. 5 However, it is important to point out that this program is not only about direct care of the GI tract, it is also a comprehensive lifestyle program. For example, I emphasize with my patients the importance of meditation and breathing in order to have a healthy gut. I studied to become a yoga teacher about 10 years ago, and that training took me from the internal medicine mind that looked at a person as a series of organs to seeing the whole person. The yoga training brought me back full circle to the type of doctor that I really wanted to become, which was a holistic-minded physician. That had to be reflected in my program, because it is not just about diet. My acupuncture training helped me to view the body as a system rather than as a Western disease diagnosis based on symptoms. It was my medical acupuncture training that led me to study Functional Medicine, which made a lot of sense after my acupuncture training, as I understood that you could look at the body as a system, which, when it becomes unbalanced, simply needs to be rebalanced.
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Finally, if a clinician is working with a patient with chronic disease and not addressing the gut, he or she is missing a big part of the picture. A person has to work at all the levels I have just mentioned, especially if that person feels unwell and wants to achieve total body wellness. One cannot simply take a diet prescription and not address the way a patient takes in stress or the way that patient is rushing through life, eating too fast and living in sympathetic nervous system overdrive. The best approach is a whole-lifestyle approach to create lasting healing for each patient, and that is how I work with my patients.▪