Enjoy this interview with him to learn how you might be able to incorporate microbiome health and wellness into your own practice!
How did you first get involved in the microbiome field?
At an early age, I was always interested in biology. In fact, I became a member of the Biology Club in my high school to have more time to explore the world of bacteria and parasites through the microscope. During that time, I was subjected to multiple rounds of antibiotics, due to the best intentions of my pediatricians to treat recurrent episodes of sinusitis and bronchitis. My gut microbiome was decimated by antibiotics like Cipro, and as a result I developed leaky gut syndrome and multiple food sensitivities. During the quest to heal my gut from the ravages of years of misguided health interventions and an inflammatory diet, I discovered Functional Medicine. That was the first time I heard about that hidden world inside us, the microbiome, which has since influenced everything I do as a clinical health practitioner.
What are you most excited about with the microbiome?
The microbiome is this uncharted territory that for years has been influencing our health; however, it is only within the last decade that research has elucidated the many critical roles the gut microbiome plays in overall health, including production of neurotransmitters, insulin sensitivity, weight management, mental health, learning, and long-term memory. I’m excited to see where this frontier takes us as we learn more about the role of the microbiome in our health.
What do you think are the best questions to ask patients to get a sense of their health habits/diet?
In order to get a good sense of patients’ health habits and diet, I like to ask them the following question: “Walk me through a typical day in your life (what do you eat).” I have found this gives me more accurate information than asking them broad questions, like “Do you eat meat?” or “Are you vegetarian?” The details are really important. For example, if they drink coffee, do they drink it black or with milk, cream or nut milk? Do they put sugar in their coffee? If so, what type? All these details are important when considering the potential effects on their gut microbiome.
What dietary advice do you most often give patients?
In general, people don’t eat enough vegetables and fiber. And non-digestible fibers are the key to a healthy gut microbiome. So I am constantly reminding people to include more vegetables in their diet. But also, to not be monochromatic in their choices. We tend to get comfortable eating within a certain range of foods, but in order to get all the nutrients and antioxidants our bodies need, we need to branch out and incorporate all the colors in the rainbow in our diets. The exception to this rule are people with markedly reduced gut function and dysbiosis (an imbalance between good and bad bugs in the gut, favoring an over-predominance of the “bad” guys). Such people lack the digestive power to break down these foods due to a damaged gut lining and paucity of probiotic bacteria to help with digestion. In these patients, I go slow, keeping within the bounds of the foods they tolerate, and vegetables are cooked (not raw) until they heal enough to started tolerating raw vegetables.
Do you have any personal habits that you have cultivated to improve the health of your own microbiome?
I incorporate fermented vegetables into my diet regularly. And I eat a variety of prebiotic-rich foods (like scallions, garlic, asparagus, dark leafy greens like dandelion greens) as well. These foods help feed and build a strong, favorable gut microbiome. I follow a plant-rich, gluten-free modified paleo diet, meaning I eat more plants than animal protein, with plenty of healthy fats. I allow dairy in the form of cheese and cultured kefir seasonally in the summer when I don’t have to worry about allergies or viruses. And I modify it by allowing some grains (like brown rice) and beans, which help improve the diversity of the gut microbiome. This is the individualized plan that works best for me after years of experimentation.
What has recently surprised you in the microbiome and functional nutrition field?
When it comes to the microbiome and functional nutrition, the level of individuality that needs to be applied to each person’s diet is extraordinary. There really is no one size that fits all. Learning how to apply individuality to the diet can be quite challenging. And knowing how to walk yourself or a patient through this challenging process is the key to overcoming many chronic health issues. That’s why, when I was asked by mindbodygreen to become one of the course instructors in their upcoming Advanced Functional Nutrition Training, I couldn’t turn it down. There is so much to share about how to tailor a diet for optimal individual results. I am excited to be part of a world-class team of doctors and nutritionists that have put together a robust, self-paced online course. For more details click here.
Where do you hope microbiome work will be in 10 years?
Within 10 years, I would love to be able to look towards microbiome testing as part of the standard of care for patients with a variety of gut-related issues (including allergies, asthma, skin rashes, and autoimmune diseases like Hashimoto’s, multiple sclerosis, and rheumatoid arthritis). I hope our ability to utilize microbiome information in a more detailed and individualized way to treat patients will have evolved even more, allowing us to choose appropriate probiotics based on testing results.
What is your biggest concern with microbiome testing?
My biggest concern with microbiome testing is that there are still a lot of unknown variables. The testing is limited by what you are looking at. So far, we have been focusing on bacteria, and sometimes limited strains of fungi. However, the microbiome is much broader than that, including the possibility of multiple species of fungi which may have made their home in the gut of individuals, along with the viome — a whole uncharted territory of viruses that live in the gut as well.
What do you think are the top three ways to improve the health of one’s microbiome?
The top three ways to improve the health of one’s microbiome are:
- Eat prebiotic-rich foods.
- Consume fermented foods and beverages.
- Take a probiotic supplement.
What is your favorite microbiome-friendly food?
Ahh, as a microbiome-friendly food, we need to turn to the fermented veggies. So many ways to do this at home are popping up. For example, KrautSource® is one company that is changing the game by offering innovative kitchenware to simplify making fermented foods.
What advice do you have for doctors who want to get more involved? What have been your go-to resources to learn more about this area?
For anyone who wants to get involved, you have to start with the basics. Learning to use functional foods as medicine is the key to long-term health. Luckily, mindbodygreen is launching a new course for the busy professional, stay-at-home mom, or health practitioner who wants to deepen their knowledge of functional food nutrition to help themselves and others live a healthier life. The Advanced Functional Nutrition Training starts November 1 but registration ends on October 26. This is a first-of-its-kind opportunity to learn from the best of the best (including Dr. Mark Hyman, Dr. Frank Lipman, Dr. Joel Kahn and myself) on a variety of topics ranging from how to stock your kitchen and follow an elimination diet, to special diets for different conditions, including gut health, inflammation, autoimmune disease, and detoxification. The best resource includes curated information from top health practitioners who have taken the time to weed through the confusion, making the latest information easy to understand and apply. That’s what this course is all about.
How do you stay up to date on the latest medical research?
I stay abreast of the latest medical research by: 1) using Google keyword notifications, 2) reading the Science Times, 3) following people who post interesting topics/research papers on social media, and 4) going to continuing education conferences, like the Human Microbiome Congress, to stay cognizant of the latest bench-side research from the scientists who are doing it.
Who are your mentors in medicine?
My early mentors before I entered medical school were Dr. Deepak Chopra and Dr. Andrew Weil. Their books (respectively), “Quantum Healing” and “Spontaneous Healing,” shaped the type of doctor I knew I wanted to become. Their words influenced me to become the out-of-the-box practitioner that I am. My mentors in functional medicine have been Dr. Leo Galland, Dr. Mark Hyman, Dr. Frank Lipman, and the great instructors at the Institute for Functional Medicine. What I admire about all of these doctors is they were not afraid to challenge our ingrained knowledge and point to another way we can view health and healing.
What is your favorite microbe?
My favorite microbes by far are the bifidobacteria. B. infantis is critical for the development of the early microbiome in children. But more importantly, bifidobacteria are involved in a feeding chain that results in the production of the SCFA (short-chain fatty acid) butyrate, which is critical for the health of the colon as well as an epigenetic regulator of learning and memory. This is one of the best examples of the gut-brain axis.