Episode 58 – Improving Gut Health with Nutrition

00:01 Announcer: Welcome to the Standing Up to POTS podcast, otherwise known as the POTScast. This podcast is dedicated to educating and empowering the community about postural orthostatic tachycardia syndrome, commonly referred to as POTS. This invisible illness impacts millions and we are committed to explaining the basics, raising awareness, exploring the research, and empowering patients to not only survive, but thrive. This is the Standing Up to POTS podcast.

00:29 Mike (Host): Hello there POTS patients and fellow people who care about POTS patients. I'm Mike Brook and today we have an episode of the POTScast about nutrition and gut health, where we will interview your normal host nutritionist, Jill Brook. Now, you may recall that Jill is a long time nutritionist here in California who also has POTS, MCAS, and autoimmunity. For the past five years, she has served as nutrition consultant to Dysautonomia Clinic. She's also a researcher and serves as the research liaison to Standing Up to POTS, in addition to being a board member. Now, we always appreciate it when you, the listeners, write in to us and suggest topics for episodes, and today we are addressing a topic requested by several listeners who asked for Jill to speak about gut health, what it is, how it relates to inflammation, autoimmunity, and general health. So, Jill, thank you for addressing this topic with us today.

01:27 Jill (Guest): Thank you for hosting.

01:29 Mike (Host): So what I thought we would do is we would talk first about what is gut health and why it matters, how it relates to some of the issues that our listeners might have, such as inflammation and autoimmunity, and then of course, what we could possibly do to improve it? How's that sound?

01:44 Jill (Guest): Sounds great! And if we could just state the normal caveats that this is not personal advice to anyone. We recognize that there is no one size fits all right diet for anyone, much less for anyone with a complex condition like POTS. So, this is just meant to be some general education about emerging findings and theories about gut health.

02:06 Mike (Host): OK. Now Jill, I've heard you say the phrase "gut health is all health," and that sounds pretty grandiose, and I will admit I'm a little bit skeptical. So I'm going to ask you on the POTScast to convince me.

02:19 Jill (Guest): OK, that is fair enough. Yeah. So, the gut has been found to have an influence on pretty much every other organ. It has been associated with autoimmune disease, anxiety, depression, cardiovascular disease, autism, COPD, liver disease, diabetes, obesity, you name it – recovering from spinal cord injuries, neurological disorders, respiratory disorders, and a lot others you know. And just as a teaser, you know, gut health is a big answer to some of the nutrition mysteries throughout the past decades that I know you heard me talk about in past decades, such as why didn't everybody lose a ton of weight when they introduced diet soda, right? Why didn't blood sugar improve from switching from regular soda to diet soda? Questions like why do people who eat more fiber tend to have better lung function, right? Those always seemed to be so different and, you know, non related in the past. Why traditionally was being born via C-section instead of a natural birth through the birth canal associated with developing more asthma, allergy, and autoimmune disease? Why do courses of antibiotics sometimes lead people to get new allergies afterwards? Why can wheat cause so many different weird symptoms in people? Gut health basically is the answer to all of these things and more. And so, I think gut health is one aspect of health that has been so underestimated and not really understood until more recently. And so I think people are still catching up to learn how and why it affects everything.

04:01 Mike (Host): OK, so we'll come back to some of those kind of mysteries here in a little bit, but let's just step back for a second. And when we say gut health, what do we mean exactly?

04:09 Jill (Guest): Basically we mean the functioning of the intestines and especially the intestinal barrier and the 100 trillion or so microbes that live there.

04:20 Mike (Host): OK, can you remind us what the intestines do for us?

04:23 Jill (Guest): Sure. So, you can think of them as like a 25 foot long tube that carries our food from the stomach to the anus, and the nutrients are absorbed during the transit time in there. We know that POTS patients may have an abnormal transit time in there, but the surface area of the intestines are pretty huge, so that they can maximize nutrient absorption. So, if you were to take the intestines out of someone and slice them open and stretch them out, they would have the surface area of - you want to guess how big?

04:58 Mike (Host): Three square yards.

05:01 Jill (Guest): The estimate is one to two tennis courts. That's insane, right? So that's going to be important in a moment. So just remember that their surface area is huge. And again, if we think of the intestines as a tube, then that means that any food in there is technically still outside the body. It has not entered the body or the bloodstream yet. And a ton of food goes through those intestines per year - and I mean that literally one ton or 2000 pounds of food on average. So that's a lot of food going through there. Kind of gross to think about, but then that last few feet of the intestines, the colon is really about storing waste products until we poop it out.

05:54 Mike (Host): So this is a tube. So you say that it's outside as food is going through there. It's not inside our body yet, but the point of it is to get it inside the body. So how does that happen? How do the nutrients get from in this tube to a place where we can do something with them?

06:10 Jill (Guest): Right. So any nutrients that we absorb into the body must pass through that intestinal barrier, which is only one cell thick and has the bloodstream on the other side. And this is a really amazing process because the intestinal barrier has to be calibrated to let in most of the good stuff like vitamins, minerals, proteins, whatever, but to keep out most of the unwanted stuff. So, think about all the stuff in food that you would not want to always absorb - things like undigested food particles, viruses, mold, bacteria, pesticides, herbicides, toxins, we know that are common in our food. You know, things like microplastics or PCB's or whatever. So that intestinal barrier is a really important border with the outside world and remember it's huge. The surface area of one to two tennis courts on average. So it is the biggest border that a body has with the outside world and it has to let a lot of stuff in all the time. So it's a really amazing design, right? So some experts compare it to a security checkpoint where it wants to let in the good guys and keep out the bad guys, which may be why so much of our immune system is located in the guts, right? So if any bad guys get in, the immune system has a presence there to take care of it quickly.

07:39 Mike (Host): OK, so the intestinal barrier is a gateway, so the nutrients pass through there. Now I've heard this term, leaky gut, which sort of sounds like a dysfunction of that intestinal barrier. So what is leaky gut and what's going on there?

07:53 Jill (Guest): Yeah. So, 'tight junctions' are the names for the little gates in our intestinal barrier that strategically open up the right amount to let in the desirable stuff. And if those get inflamed or damaged or too permeable or leaky, then they stay too open for too long, which means potentially letting unwanted junk from the intestines to get into the bloodstream.

08:23 Mike (Host): So that sounds bad. What happens if this junk gets in?

08:26 Jill (Guest): Well, it probably depends a lot on what kind of junk it is and how much. But, one thing is that the immune system might just simply do its job. It might identify some junk in the blood as something that it does not recognize or trust, and it could mount an attack, which could lead to inflammation, maybe chronic inflammation if you're chronically getting that junk in. Or in susceptible people, it's theorized to potentially lead to autoimmunity.

08:56 Mike (Host): OK, so this is starting to connect to the POTScast, I guess, and so I know that a lot of our listeners are very familiar with inflammation and autoimmunity, but could you just define them? Make sure everybody knows what they are.

09:09 Jill (Guest): Yeah, sure thing. And to be clear, gut health problems are not the only way to get inflammation or autoimmunity. They're thought to be a big way, but just to be clear on that. So, inflammation is basically just an immune response to an injury or a pathogen. It's necessary, and it's helpful for healing a wound or fighting a virus or whatnot, but it does result in some collateral damage of the surrounding tissue, and that's not generally a big deal. If the inflammation is brief, you know, if it just does its job and then stops, but if there is chronic inflammation, then that collateral damage ends up accumulating and isn't healthy, right? So, chronic inflammation underlies numerous different diseases, and I think a recent letter of concern signed by 22 scientists even said that chronic inflammation is responsible for over 50% of deaths worldwide. So chronic inflammation, you know, big problem. Now, autoimmune disease is one type of chronic inflammation where, according to the theory of molecular mimicry, the immune system may identify a threat, like say a virus for example, create an antibody against that threat, but then if that person is unlucky enough to have some healthy body tissues that resemble that threat at a molecular level, then the antibody will cross react with that tissue. In other words, it attacks both the virus and the healthy person’s tissue. So, there are over 100 different autoimmune diseases and they're named for which type of tissue is being attacked. So, for example, Hashimoto's disease is when the immune system attacks the thyroid. Type one diabetes is when the immune system attacks islet cells in the pancreas. In MS, it's the myelin sheath around the neurons, and so on.

11:04 Mike (Host): OK, so the leaky gut is really what allows this intestinal junk into the bloodstream, and then the immune system is just doing its job. It's just saying, "This is stuff that I'm not happy with, it's a threat," and that's why it can trigger inflammation and perhaps even autoimmunity. Is that right?

11:21 Jill (Guest): That is the theory, yep. And a recent paper by Dr. Datis Kharrazian also showed a way that even like pollutants like microplastics could do it too. He has a paper that suggests that microplastics or other contaminants can get in the bloodstream and attach to our own proteins, like just the albumin floating around in the blood. And now since that protein has a microplastic attached to it, it is a different shape and now the immune system might not recognize it as a friendly protein anymore, and so that could set off the immune system. So, you know, especially as the world gets more polluted, it probably matters ever more that our bodily barriers with the outside world don't get overly permeable or leaky.

12:07 Mike (Host): OK. So, yeah it does sound like it would be important to keep your gut unleaky, but what leads to leaky gut? What causes this?

12:15 Jill (Guest): Well, a lot of things have been found to contribute, including infections. For example, even COVID is being investigated for being able to cause it. Wheat gluten contributes because it results in signals to open up those tight junctions. Excessive alcohol has been found to do it. I believe a study found that 4 drinks a day for four days in a row was enough to do it. Don't quote me on that, but I think those were the numbers. Excessive use of NSAIDS - those non steroidal anti inflammatory drugs - can contribute. Stress, personal food intolerances. A big one with more evidence coming out is industrial food additives, like in processed foods. And then another big factor that we can at least partially control is dysbiosis.

13:06 Mike (Host): Can you define dysbiosis for us?

13:08 Jill (Guest): Sure. Well probably everybody listening remembers that we each have a huge community of microbes that live in us and on us with over 1500 different species of bacteria, fungi, yeast, viruses, etc. And the biggest part of our human microbiome is in our colon, doing lots of important things for us. And when our gut microbiome has not enough friendly microbes and/or too many unfriendly gut microbes, we can get out of balance, and that is dysbiosis.

13:41 Mike (Host): Aha, OK. So this is where we invite the microbiome in here to the conversation. This is to me, really, is the most interesting part. And we had a cartoon a while back - we had a Doodle Thruthing - where we spoofed these Russian military posters from the 50s where there was this bacteria or something that was wearing a beret. And it was saying something like "Your microbiome, 100 trillion friends or foes, depending on how you treat them." [Transcriber’s note: you can view that cartoon here - https://www.doodlethru.com/tag/Microbiome?view=large#246] So, in the case of dysbiosis, there seems like there are clearly too many foes, but if we have a good army of microbes, what are they doing for us? What do they do ideally?

14:11 Jill (Guest): Well, they do a lot of different things, which is why we ideally want a very very diverse microbiome, because different ones do different things. And, you know, the one thing we know more than anything else about the gut microbiome is that more diversity of species is associated with better health, less inflammation, less autoimmunity and a load of good health outcomes. And that is probably because each different species does a different, valuable job for us. Things such as extracting calories or nutrients from our food, actually producing some nutrients, like we know that they make vitamin K and folic acid. We know they make arganine and glutamine. They participate in drug metabolism. They help break down toxins. They prevent colonization by pathogens. And then they have a lot of immunological effects, helping the immune system to do its job, fighting pathogens, and then not be overly inflammatory in the process or against, you know, innocent things. And then one other thing they do that's really important is they produce something called 'short chain fatty acids', which are the building blocks of a healthy gut barrier. So, in essence, our gut microbes help repair and maintain that gut barrier that's so important.

15:38 Mike (Host): Aha. That's if they're on our side, but I think we're going to cover in a minute why and how they can turn to the dark side. But let's say they do turn to the dark side. Now what are they doing to us?

15:48 Jill (Guest): Well, I think we're still learning about everything they're doing, but one big thing is that they can produce metabolic byproducts that can be toxic. And if you have a leaky gut and dysbiosis, and those toxic byproducts can get through that gut barrier and into your bloodstream - called endotoxemia - and that can cause pretty severe systemic inflammation and all sorts of bad symptoms.

16:15 Mike (Host): It sounds like - you said diversity was key, so avoiding sort of a monoculture and kind of a groupthink seems to be kind of the big deal here, and if you do that can have a pretty huge effect, it sounds like.

16:27 Jill (Guest): Yeah. Can I give you just a couple examples of completely mind-blowing findings?

16:32 Mike (Host): Of course, yes.

16:34 Jill (Guest): OK. So one study took genetically identical mice - all of them on the exact same diet - and altered the gut microbes in some of them. And just that one difference made it so that some of the mice became obese afterwards, even without eating any more or exercising any less. The only difference was the gut microbiome. Another similar study altered the gut microbes of mice and was able to make them either have virtually no reaction to a respiratory infection or to have a huge inflammatory reaction to that same infection. Similar studies have shown that just altering the gut microbes can make mice act either more sociable or more anxious or depressed. There are lots of similar studies showing that gut microbes can have a really big effect on both mental and physical health. In fact, remember at the beginning how I said, we think gut health seems to explain why children born via C-section traditionally had more allergies, asthma, autoimmune disease, and even depression?

17:42 Mike (Host): Yeah.

17:43 Jill (Guest): Well, it's thought that the reason is that a C-section birth robs those babies of the trip down the mother birth canal, where they would normally get a mouthful of the mom's microbes, which would then start their own nice, diverse colony of microbes. It kind of would serve as their anchor tenants, right? So they would get this mouthful of all this nice diverse microbial stuff, but in a C-section they don't get those microbes, right? They just have somebody slice the stomach and, wearing sterile gloves, take them out of the mom’s stomach, and so they don't get exposed to those same microbes. Nowadays, now that this is known, many birthing centers apparently know this, so they will take a sponge and they will wipe up some of the fluid from the birth canal and put it on the baby’s lips to help them still get those initial microbes if they have to have a C-section. But that is how powerful these microbes appear to be.

18:42 Mike (Host): Aha, OK. All right, so we need to make them more friendly. So the question is, how do we do that?

18:47 Jill (Guest): Well, the good news is that our microbes have to eat whatever we give them - whatever we eat. So, the reigning thinking is that we can eat to feed the good microbes and starve the bad ones. And we can avoid the chemicals and the industrial additives that would tend to disturb those microbes.

19:05 Mike (Host): And what exactly would I feed these microbes to, you know the good ones, to make them flourish?

19:10 Jill (Guest): So the big thing is to eat more plant fiber from whole foods. And again, the key is really diversity, meaning we want to maximize the variety of plant foods we can get every month or so. So, you know, variety of fruits, veggies, beans, legumes, whole intact grains, herbs, spices, nuts, seeds. Now, I know a lot of POTS patients cannot tolerate a lot of foods, so within whatever you can tolerate, maximizing the variety is the key.

19:38 Mike (Host): OK. So, I would like to ask you to share a little bit about your own personal strategies for cultivating a diverse microbiome because your eating habits are noteworthy and remarkable, and always a source of surprise. So what are you doing anyway?

19:56 Jill (Guest): [Laughs] I tend to make a game out of seeing how many different plant foods I can add to every meal. So if I'm making oatmeal and blueberries, for example, I will see can I add some spices? Can I add some nuts? Can I add some seeds? Can I add, you know, whatever. I try to eat the rainbow. I try to eat different parts of the plant. So everyday I'm looking to eat some roots and some leaves and some shoots and some seeds and stalks, some fruits, whatever. Just playing a game to maximize diversity.

20:29 Mike (Host): OK. While we're talking about you, can you shed some light on this jar of kimchi that's been kicking around our refrigerator for the last six years? I'd never seen you eat any, but it does seem to move from one side of the fridge to the other occasionally. What's up with that?

20:43 Jill (Guest): I'm hoping to osmose the probiotics.

20:47 Mike (Host): Does that help?

20:48 Jill (Guest): [Laughs] No. Eating any tolerated probiotic foods might help, like sauerkraut or kimchi or yogurt - these fermented foods that have the beneficial bacteria right on them. And you're right, I have kimchi kicking around that I rarely eat because it tastes horrible and I don't tolerate it very well, but I have high aspirations.

21:13 Mike (Host): OK. So I know a lot of our listeners probably wouldn't tolerate something like kimchi because it's very high in histamines and all that kind of stuff. But what about probiotic supplements? Is that something you could take that would get the job done?

21:25 Jill (Guest): The research on that is not as strong as I would hope. There are some studies showing some specific benefits for some conditions and some strains, but I don't know of anything specifically for POTS or autoimmunity or anything shown to be really good for everybody. But I know there's a ton of research on this right now. Hopefully something will come out soon that we can really rely on. In the meantime, I know a lot of people who try things, and maybe they sometimes find something that they think helps them or not. Some people actually find that the probiotics might make some of their symptoms even worse, like, especially if they have SIBO [small intestine bacterial overgrowth]. But that's one of those things where it theoretically it should be so amazing, but so far I think the research has not been quite as positive as we would maybe hope.

22:11 Mike (Host): Is there a chance we could sort of play defense instead of offense here, and sort of starve the bad microbes by eating certain things or maybe not eating certain things?

22:20 Jill (Guest): Yeah, absolutely. The thinking is that you can starve the bad microbes by avoiding foods like excess sugar, excess alcohol, processed grains - basically any very highly processed foods that some of the bad microbes might thrive on.

22:37 Mike (Host): OK. Now, I have heard you rail against certain food additives and the types of sort of unnatural chemicals that might ride in on our foods, and I'm guessing that those disturb the microbiome. Can you talk a little bit about those?

22:50 Jill (Guest): Sure. Foods that are very full of preservatives or industrial additives - often because they have purposely put in antimicrobials into the foods to keep them from getting bacteria or mold or whatever - sometimes those chemicals that prevent bacteria in our food can also theoretically affect bacteria in our gut. Another suspect is antibiotics in foods, right? They're good for keeping chickens from getting infections, but if we eat a whole lot of that, then it's also thought to have an effect on our microbes. And so that would be a couple of examples. Oh, another one is artificial sweeteners such as Splenda and Nutrasweet. Those disturb gut microbes and make us more glucose intolerant. And in our last nutrition episode we talked about how POTS patients are already maybe at higher risk for becoming glucose intolerant. So, just something to pay attention to. But you know, older listeners might remember back in the 1980s when we thought diet soda was gonna help so many people lose weight and reduce their blood sugar because they could get all the flavor without all the real sugar. And it was a big mystery for many years why that didn't actually help. But eventually the research came through and it figured out that these artificial sweeteners have such a strong negative impact on gut microbes that it actually offsets all that sugar in the soda.

24:20 Mike (Host): I'm cringing at all the Splenda and Nutrasweet that I consumed in the 80s and 90s.

24:25 Jill (Guest): I know me too, yeah.

24:27 Mike (Host): So, if I were going to sum up what's bad, it sounds basically like what you're describing here is the standard American diet. It sounds like that's kind of about the worst thing you could do for your gut health.

24:35 Jill (Guest): Yeah, and you know, we already knew that the standard American diet is bad for a lot of different kinds of health. But yes. So it's low in fiber, low diversity of whole plant foods. So yes, it's not very good for gut health. You know, there's some research findings that really bear this out that cultures that eat mostly processed food or fast food have much less microbial diversity in their guts. They have more inflammatory diseases, more auto immunity, whereas cultures that still eat a very traditional diet - like there's a few societies that still are hunter/gatherers out there - and they have much more microbial diversity and much less autoimmune disease or chronic inflammatory disease.

25:21 Mike (Host): OK, a wide variety of plant foods, avoiding some of those bad things like alcohol and sugar and Splenda and pesticides and that kind of stuff is kind of what we're shooting for. However, I know there are a lot of people out there with gastroparesis or food intolerances that might make it very difficult to do that - to feed your good microbes in that way. So, what can someone like that do for good health?

25:44 Jill (Guest): Yeah, definitely. There's a lot of listeners who probably hear, you know, "eat a large variety of plant foods." That sounds super impossible for me. My symptoms would be terrible. So what they could do is at least avoid the things that disturb the gut microbes. So basically quit throwing fuel on a fire - so avoiding things like Nutrasweet or Splenda. Quite a few of the electrolyte drinks out there do have Nutrasweet or Splenda in them, so it's worth checking to make sure you're not doing those unnecessary antibiotics or something you could avoid. You could also do something recommended by Dr. Datis Kharrazian, which is to make a veggie mash where once in a while you buy as many different veggies as possible, put them in a blender, make a slurry, you know, grind them all up together and then freeze it in an ice cube tray so that whenever you are able to tolerate a couple bites of vegetable fiber, you could thaw a piece from the ice cube tray, and then in just a couple of bites get a really nice big variety of different plant foods. And then finally I would recommend that people try to eat the wide diversity of whatever real or whole food they can tolerate, even if it means eating some foods that are not your favorite. Because if you eat just a couple different foods 'cause you're a picky or whatever, then that can theoretically become a bit of a vicious cycle.

27:16 Mike (Host): So vicious cycles are something we're very familiar with here in the POTS universe. What is this vicious cycle that you're talking about?

27:23 Jill (Guest): Well, if you limit yourself to just a couple foods, then gut microbiome diversity decreases, which can make the immune system more aggressive, more inflammatory and less tolerant, which could then make you more reactive to the next food that you try, right? So, among experts in gut health and autoimmunity, one big piece of advice that commonly comes up is to eat the widest variety of things you tolerate well, because that helps teach your immune system to be more and more tolerant, right? So, eating more variety is thought to lead to a virtuous cycle of greater immune tolerance of more different foods, whereas eating the same two foods everyday - day in and day out - may lead to a vicious cycle of non tolerance of new foods.

28:11 Mike (Host): Aha, OK. All right, so let's say you did happen to have a leaky gut, and maybe it's resulting in chronic inflammation or even an autoimmune disease. Can you heal this? Is this something you can fix, and if so, how?

28:26 Jill (Guest): Yeah. So, some practitioners specifically specialize in this, but the first step is typically to try to figure out what factors are contributing - you know, do you eat a lot of processed foods or sugar or alcohol? Do you have a lot of stress or bad sleep? Do you take a ton of NSAIDS for pain? Might you have SIBO creating dysbiosis, you know, all these things to consider and for some people it's a lot more complex than it is for others. You know, for people who are able, eating more whole real foods and less processed food is key. If able, eating less factory farmed foods full of antibiotics and other chemicals or preservatives can help, and often that is enough. Now, for people with really bad gut health, there are some supplements that are thought to help, and a good practitioner can help people with this. They can even test for leaky gut, so you know for sure. But if you're not too far gone, then really just cleaning up your diet can go a really long way, and that's enough for a lot of people.

29:29 Mike (Host): So, your practice is a wide diversity of plant foods, but every once in a while there will be a crock pot full of bones cooking in our kitchen and you're making bone broth. What's that doing? Is that a leaky gut thing?

29:43 Jill (Guest): Well bone broth is thought to have a lot of benefits and a lot of nutrients, but one of the things it's thought to be good for is helping to heal a leaky gut, yes.

29:53 Mike (Host): OK, so if you were to sort of do some of those things that you mentioned, clean up and start eating cleaner, is this the kind of thing that heals up quickly is this take years or decades? Or how fast could this possibly change?

30:02 Jill (Guest): Well, of course everybody is different and everybody mileage may vary, but one study showed that the gut microbiome could change drastically in just five days when participants changed their diet pretty drastically. And, you know, that's not really surprising given that one generation of microbes only lives for about 20 minutes, right? So, microbial empires can rise and really fast. Now, they can evolve fast in the good direction or the bad direction, so you have to maintain those better eating habits if you want to maintain the gut microbiome that goes with it. But the other good news is that gut tissue is one of the fastest healing tissues in the body, and many of us POTS patients have small fiber neuropathy. So some of us know that nerves are very slow to heal by contrast, but the gut is about the fastest, so that's some good news. But I don't want to give false hope or make unrealistic promises, right? There are things besides diet that can affect gut health, so it's not a total guarantee that you just clean up your diet and instantly feel amazing, but certainly some people do, and if you have been eating a standard American diet, you probably have a lot of potential to improve gut health.

31:17 Mike (Host): So, is there a chance that if you did improve your gut health you could actually stop an autoimmune condition maybe?

31:23 Jill (Guest): Yeah, according to some experts like Alessio Fasano - he's a great researcher at Boston Children's Hospital, I believe. His studies say that if you address gut health, it may halt autoimmune processes, right? Because if the reason your immune system is so angry is because the intestinal junk is getting in and setting off the immune system, then theoretically keeping that junk out will help a lot. But just to be clear, you know, there can be other reasons your immune system would be angry, like a hidden infection, for example. The gut is not the only reason a person could have inflammation or autoimmunity, but it is thought to be a big one.

32:08 Mike (Host): So, a few minutes ago you talked about this sort of nutritional mystery, which was sort of the Nutrasweet/Splenda thing where everybody started drinking diet soda, which has no calories, and yet people didn't lose any weight, and their blood sugar didn't even really improve. And the reason is that it disturbed the gut microbes in such a way that made them more glucose intolerant. So it pretty much had the same effect as if they had just had the sugar all along. But there are some other mysteries too, so maybe we can visit a couple of those. So you alluded to something where people that eat more fiber tend to have better lung function. Why would that be?

32:42 Jill (Guest): Yeah. So, researchers are learning that just like there is a gut/brain axis where the gut and the brain affect one another a whole lot, there's also a gut/lung axis. And the Mayo Clinic has some researchers reporting that the gut microbiome appears to have significant effects on the lungs and eating fiber of course improves the microbiome and so for one thing, it can reduce inflammation, but there may be some other ties as well that they're working on.

33:11 Mike (Host): You know, I've heard of people getting new allergies after doing a course of antibiotics. Does this have any connection?

33:19 Jill (Guest): Yes. The thinking is that the antibiotics can kill off some gut microbes, changing the balance of the microbiome and leading the immune system to be less tolerant or more aggressive, you know, i.e., more allergic.

33:34 Mike (Host): Can you speak for a minute about wheat? I mean, wheat seems to be associated with lots of sort of weird and different symptoms, and this is apart from celiac disease. Why is that?

33:45 Jill (Guest): Well, there can be a few things about wheat, and wheat can mimic some proteins in the body and you can get antibodies cross reacting. But when it comes to leaky gut, it appears that wheat gluten signals the tight junctions of the intestinal barrier to open up, even in people without celiac disease. And so, that would let more of that stuff in from the intestines - let it enter the bloodstream and from there the variety of reactions can be pretty diverse.

34:14 Mike (Host): Interesting. Are there any favorite resources that you have on gut health that you go back to time and again that people might find interesting?

34:21 Jill (Guest): Yeah. Yeah, there's a husband/wife research team at Stanford University that I like. They're named Erica and Justin Sonnenfeld. They have a book called The Good Gut: Taking Control of Your Weight, Your Mood, and Your Long Term Health. So that's a great place to start. [Transcriber’s note: correction – Erica and Justin Sonnenburg. You can visit their website here - https://sonnenburglab.stanford.edu/] Dr. Terry Wahls also has some great books, videos, and resources for people interested specifically in halting autoimmune disease. She is very inspiring because she reversed her own MS. She went from being wheelchair-bound to bike riding and now she conducts a lot of research on all of this and has a program called the Wahls Protocol. [Transcriber’s note: you can find Dr. Wahls’ website here - https://terrywahls.com/] And then for anybody who has a super complex set of disorders and feels like their gut health is just messed up beyond just only dysbiosis and intestinal permeability, I keep mentioning Dr. Datis Kharrazian, who does a lot of amazing research, but he also has some books and videos and you can find him online as well. [Transcriber’s note: you can find Dr. Kharrazian’s website here - https://drknews.com/]

35:21 Mike (Host): All right, that's great. So, that is a very fast, but I think very thorough tour of gut health. Thank you so much, Jill, for sharing all this with us today.

35:32 Jill (Guest): I have to ask, did I convince you that I'm not grandiose and that gut health is all health?

35:37 Mike (Host): You convinced me of the amazingness of the intestines, the amazingness of the microbiome. You convinced me that the colon is kind of the laughingstock of the bodily organs. I'm not really impressed with the colon.

35:50 Jill (Guest): [Laughs]

35:50 Mike (Host): But everything else I'm pretty impressed, I'll admit.

35:51 Jill (Guest): All right, OK, I'll take it.

35:53 Mike (Host): You did. So, hey listeners - remember this is not dietary or medical advice. Please consult your healthcare team about what's right for you. And please consider subscribing because it helps us get found by more great people like you. And thank you very much for listening. Remember, you're not alone and please join us again very soon.

36:13 Announcer: You can find us wherever you get your podcasts or on our website, www.standinguptopots.org/podcast And I would add, if you have any ideas or topics you'd like to suggest, send them in. You can also engage with us on social media at the handle @standinguptopots. Thanks for listening and we hope you join us. This show is a production of Standing Up to POTS. © 2022 Standing Up to POTS. All rights reserved. [Transcriber’s note: If you would like a copy of this transcript or the transcript for any other episode of the POTScast, please send an email to volunteer@standinguptopots.org]