PRECONCEPTION

019: Is Gut Health Important For Pregnancy? w/ Vincent Pedre, MD

019

019: Is Gut Health Important For Pregnancy? w/ Vincent Pedre, MD

Welcome to the Hey Mami podcast!

Our guest today is Dr. Vincent Pedre, the Medical Director of Pedre Integrative Health and Founder of Dr. Pedre Wellness, nutraceutical consultant for NatureMD and Orthomolecular Products, CEO of Happy Gut Life LLC, and a Functional Medicine-Certified Practitioner in private practice in New York City since 2004.

He believes the gut is the gateway to excellent wellness. As the bestselling author of “HAPPY GUT®—The Cleansing Program To Help You Lose Weight, Gain Energy and Eliminate Pain,” featuring his proprietary ‘blueprint’ for healing the gut, the Gut C.A.R.E.® Program—he has helped thousands around the world resolve their gut-related health issues.

Or listen on Apple Podcasts | Spotify | Stitcher | TuneIn | YouTube

In today’s episode we are talking about the importance of gut health for preconception and beyond.

Highlights:

  • The importance of the microbiome in preconception health, in a healthy pregnancy, in postpartum, and beyond
  • How is the microbiome of the mother related to the microbiome of her child?
  • What are some of the most common patterns that might present for people when they’re dealing with gut issues?
  • Why does stress affect the gut?
  • Dr. Pedre’s favorite supplements to support better gut health

Important Links

Find Dr. Pedre online

Dr. Pedre’s FREE guide: Top 10 Tips for a Healthy, Happy Gut

Dr. Pedre’s book, Happy Gut

Quotes

“High cortisol will actually cause alterations in the gut microbiome, and, because it raises blood sugar, can then lead to yeast overgrowth in the gut.”

“The leakier your gut is, the more inflammatory substances are going to get through into your bloodstream.”

019: Is Gut Health Important For Pregnancy? w/ Vincent Pedre, MD TRANSCRIPT

Dr. Carrasco:                      Welcome back to the Hey Mami Podcast. Our guest today is Dr. Pedre. He is my brother from another mother, and we are so happy to have him here today. Thank you for joining us.

Dr. Pedre:                           It’s so great to be here. Thank you for having me, my soul sister. Yes. We even kind of look alike, if you could see us.

Dr. Carrasco:                      I know it.

Dr. Pedre:                           We look like we were separated at birth.

Dr. Carrasco:                      I think we were.

Dr. Maren:                          Yeah. You guys could be brother/sister, for sure.

Dr. Carrasco:                      I do think that we were.

Dr. Maren:                          It’s funny.

Dr. Carrasco:                      All right. Dr. Pedre, tell us why you do what you do, and share with our listeners your story.

Dr. Pedre:                           God … It’s really the thing that I thought was my biggest crux that has become the avenue by which I serve people in the world. It started as a child, getting throat infections, lung infections, pneumonia, bronchitis, sinusitis, pharyngitis, over and over. I’ve calculated that I was on probably two to three rounds of antibiotics every single year, starting at 10, through my teenage years, so 20+ rounds of antibiotics, which completely destroyed my gut microbiome. I can only say this now in retrospect. I didn’t know this back then, and nor did my parents. They kept taking me to the pediatrician who kept just giving me antibiotics. When the antibiotics didn’t work … I don’t know if you remember this. Back then, this is the ’80s. They used to give gammaglobulin shots, so pulled globulins from people who donated blood. I would sometimes have to get a gammaglobulin shot, because I wasn’t even responding to the antibiotic.

Dr. Carrasco:                      Wow.

Dr. Pedre:                           No one ever stopped to ask, “Hey, what’s going on here?” I had gone through my growth spurt. I couldn’t gain any weight. I was super thin. Looking back, I know that I had developed leaky gut from the dysbiosis, the imbalance that was created by all the antibiotic rounds. I became sensitive to the two biggest food groups in my diet, which were wheat and dairy. A lot of times they happen together, like cereal with milk in the morning, or a sandwich with cheese, or pizza. Every day when my mom would pick me up from school, starting in, I think, elementary school, we would stop at Burger King for a vanilla milkshake on the way home.

Dr. Pedre:                           All the things that I know now as a doctor whose practice is functional medicine, I would’ve told my parents, “You need to stop giving him dairy. You need to take him off of wheat. We need to start fixing his gut, because he’s been on too many rounds of antibiotics.” That is really the gift, because having grown up with these issues, and then developing what would’ve been just classified as irritable bowel syndrome as a teenager into my early adulthood, not understanding why my gut behaved the way it did, and why kind of sometimes I felt sick when I ate out. I didn’t understand … I wasn’t keen to what the patterns were, so I had no idea. I thought it was all random, and yet now, when I look back, I realize it was dairy. It was the wheat. All of that was causing problems with my gut permeability. Made me run to the bathroom.

Dr. Pedre:                           It wasn’t until I discovered functional medicine that everything started making sense. I realized that what I thought was my normal, which was to have IBS, to have a really sensitive stomach, to not know when I went to eat out if something was going to agree with me or not, and if I was going to have to run to the bathroom. To then realize that it all had to do with my gut microbiome, that my gut microbiome had been destroyed as a child. Even 20 years later, I was still paying the price for all the antibiotics that I had been on, but that it didn’t have to be my normal. That’s when I started taking probiotics, changing the diet, incorporating more vegetables, more prebiotic foods. Really being careful about what we bought at home, like organic pasture raised meats, organic vegetables. No pesticide laden apples. Which I realize, in retrospect, any time I ate a nonorganic apple that I would get sick to my stomach. I thought, “Do apples just not agree with me? Is it the pectin? Is it the fiber in the apple?” Really, it was the pesticides.

Dr. Carrasco:                      It’s the poison.

Dr. Maren:                          More antibiotic.

Dr. Pedre:                           Yeah.

Dr. Maren:                          Right?

Dr. Carrasco:                      It’s the poison in the apple.

Dr. Pedre:                           Anybody who looks at the Environmental Working Group website, and knows the dirty dozen and the clean 15, that apples are in that dirty dozen list. Anything that has a really thin skin is going to have those pesticides penetrated into the flesh of the fruit. When you’re eating the fruit, it’s going to affect your gut microbiome more, I think, than people realize. It was those details like that, like thinking, “Well, I’m eating an apple, and an apple away keeps the doctor away. Aren’t apples healthy? Why do I feel sick when I eat an apple?” Then you realize, “Oh, wait a second. If it’s an organic apple, I actually feel okay. If it’s a nonorganic apple, and I eat the skin, I start not feeling so great.” I really became aware of how diet affects health, and also realized that what I had wasn’t a lifelong sentence, that it wasn’t that something was wrong with me, and that I would just live this way. This was my matrix.

Dr. Pedre:                           It’s funny, because, one time, it took my sister a really long time to realize. Not only realize, but to accept that I was gluten free, and that that was part of how I had to live. I don’t think she really realized it until her son, my nephew, my godchild, developed hives. It turned out that it was gluten that was triggering the hives. He had to go on a gluten free diet. When her son had to go on a gluten free diet, which was probably six years after I had been telling her, “I’m gluten free,” and she would offer me a croissant when I would go out to the-

Dr. Carrasco:                      Here’s a [Spanish 00:06:56]

Dr. Pedre:                           Yeah, exactly. I’m like, “No. I can’t eat that, because I’m gluten free.” Or we go to an Italian restaurant, and I’m like, “You realize you’re taking me to the one restaurant where I have the least amount of options.” We were at an Italian restaurant, and I ordered a salad with protein. She actually said to me, “You have food issues.” I’m like, “No, I don’t. I eat a lot of what is good for me, and I don’t eat what I know is bad for me. I don’t have food issues. I eat a lot of food. It’s just I’m not going to eat what I know is going to disagree with my system.” It was a journey, not just for myself, but also for my family, to now realize that. I think it was like two Thanksgivings ago that my sister finally made a gluten free dish for me. I’m like, “Oh my God. It took you six years to understand that I’m gluten free, and that I can’t eat pie because the dough has gluten in it.” I’m sure people were-

Dr. Maren:                          Was she like, “You could just eat the filling, though.” You’re like, “No, no, no. You don’t get it.”

Dr. Carrasco:                      It doesn’t work that way.

Dr. Pedre:                           It’s already contaminated.

Dr. Maren:                          Yeah.

Dr. Pedre:                           I think anybody listening probably understands the difficulties of when you go on a healing journey and your family is really not educated, or on board with it, or doesn’t understand. “What is that gluten thing? That’s just a fad.” Well, it isn’t. If it’s an issue that affects your body, it’s not a fad. That was my healing journey. Part of it was standing on my own and saying, “You know what? I’m gluten free, and it’s okay that I’m gluten free. I’m willing to be judged for it, and for people to look at me funny and be like, ‘What? You can’t eat that?'” I’m like, “Yeah. I’m not going to eat that, because I know it’s going to damage me.”

Dr. Carrasco:                      I think that learning how to advocate for yourself is such an important part. I think all three of us have had our own health journeys where advocacy is very important, but I think for our listeners, and for our patients, that’s part of their journey as well. To your point, Vincent, something that you said that was interesting was that your sister realized the impact of gluten, the issue on the gut, when her child had issues. Our listeners, especially for this episode, are interested in preconception health and growing their families. Generally, I would say parents, and moms especially, will do whatever it takes so that they can have a healthy baby, so that they can have a healthy child. I would love to kind of dive in with you about the importance of the microbiome in preconception health, in a healthy pregnancy, in postpartum, and beyond, because that really is an important foundation. I’d love to hear kind of your thoughts on it.

Dr. Pedre:                           First of all, we have to think that most women come in to their doctors, and they tell them, “I’m planning to get pregnant next month.” Preconception health should really start six to 12 months before you decide to get pregnant. I think the longer time the better, because the truth is anybody who’s planning to get pregnant, I’m sure if they could raise their hands right now. “Have you ever been on antibiotics?” “Yes.” At some point, maybe you had a UTI and your doctor put you on levofloxacin or Cipro. Just a five day course of Cipro will take your gut 12 months to recover from that. Just one five day course of Cipro. Or you had a cold. You had a sinus infection. You went to your doctor, and you said, “Hey. Give me an antibiotic so that we can knock this out. Nip it in the bud.” They give you, then, a Z-Pak, one of the most commonly prescribed antibiotics. Again, five day course. Six months for the gut microbiome to recover from those five days.

Dr. Pedre:                           When you think about everything that happens in the gut that relates to not just the health of the mother, but the health of the pregnancy, leaky gut is a really important consideration, because the leakier your gut is the more inflammatory substances are going to get through into your bloodstream. Actually, there was a study that I read a couple of months ago that showed that we could even have bacterial DNA was found in the bloodstream. It was more likely to find that in people who had leaky gut. Now, how are you going to get leaky gut? Number one, going on a round of antibiotics, because the antibiotics are going to change the makeup of the gut microbiome. It’s going to probably kill off some good bugs that are helping your gut lining stay intact. It’s this beautiful semi-permeable membrane interface that needs to allow only good things in and keep the bad things out.

Dr. Pedre:                           When your gut becomes leaky bad things can get through, which can be endotoxin, which comes from gram negative bacteria, one of the most inflammatory substances out there, or even mycotoxins from yeast. A lot of women in my practice have sugar cravings. With this, the underlying reason for many of them could be yeast overgrowth, candida. When you have that, you know you have a dysbiosis. If you have a dysbiosis, then you have leaky gut. You can’t fix a semi-permeable membrane that is the size of a tennis court in one month. You really have to start thinking about that six months, 12 months, in advance.

Dr. Pedre:                           Now, throw in alcohol. Throw in stress, which is like an attack on your gut that also increases the permeability of the gut, but also can alter the gut flora. Then you’ve got a lot of hits. Then throw in the standard American diet, eating food on the go, eating packaged foods. All of these things alter the gut microbiome in ways that are unhealthy for a woman who’s thinking about getting pregnant, and preconception planning, because you really need time to work on the gut. Work on reestablishing balance in the gut microbiome. We can talk about the things.

Dr. Pedre:                           There’s actually a recent study that came out that showed where they looked at. It was actually primarily a cohort of women who were studied for 10 weeks. They divided them into two groups. One group had a high fiber diet, and the other group was given a high fermented food diet. What they found was kind of a little bit different than from, I think, a lot of our functional training, because you would think that. If I would ask you, “What’s going to increase microbial diversity, and reduce inflammation?” You might think it’s the high fiber diet, but it wasn’t. It was the high fermented foods diet that increased the diversity of the gut microbiome. For everybody who is listening, diversity is the holy grail. If you want to be healthy, you need a diverse gut microbiome. Two, a high fermented foods diet lowered 19 inflammatory markers that they measured. The fiber rich diet did not lower inflammatory markers. It did not increase microbial diversity. Now, one thing to say to that is it was only a 10 week study. It was a small cohort. Maybe fiber would’ve increased the microbial diversity if they had studied it for longer.

Dr. Pedre:                           The one thing fiber did do, though, because we know fiber is really important. Don’t listen to this and say, “Oh, I’m just now going to eat sauerkraut, and pickles, and drink some kefir, and forget all my fiber.” No. What fiber did, depending on the baseline microbial diversity of the person’s gut, is it improved how the immune system behaved. Fiber was an immunomodulator.

Dr. Maren:                          Interesting.

Dr. Pedre:                           For anybody who’s been worried about getting sick throughout the pandemic, or even just flu season, and what not, you want your immune system to be functioning properly. You want it to not overreact. One of the ways that we can do that is through the information we give our bodies through food. When you’re eating, you’re not just eating for yourself. You’re eating for your gut microbiome. When you feed your gut microbiome fiber, it’s producing all these postbiotic metabolites known as short chain fatty acids. Some of them are anti-inflammatory, but somehow they also interact with our immune system. They keep the immune system from being on hyper alert, which is also really important.

Dr. Pedre:                           When we think about the things that you can do if you’re thinking about preconception planning, you can go as fancy as working with a functional medicine doctor. Getting your gut checked out if you have gut symptoms, or if you have gut related health symptoms, so if you’re suffering from mental fog, if you’ve got sugar cravings, if you have allergies, asthma, if you suffer from migraines, if you have joint aches, if you have fatigue in your body that you feel is out of proportion to the amount of rest and activity that you have, then you’ve got to look at your gut. Of course, you look at the hormones as well. You can do gut testing and see. Do a stool PCR and get at least some picture of what’s happening in the gut.

Dr. Pedre:                           Then you want to start thinking about maybe you take a probiotic supplement. Maybe you’re not eating enough fiber. Are you pooping every day? Poop is so important. You’ve got to poop to get rid of toxins. You poop to get rid of estrogen that’s been metabolized, so pooping is one way that you prevent estrogen dominance in your body, which is really critical and important to think when you’re doing preconception planning, because you want your hormones to be balanced. Your gut is an integral part of hormone balance in the body. We have a whole section of the microbiome that’s called the estrobolome. That is basically just dedicated to metabolizing estrogens, whether they come through food, from your environment, from maybe your drinking water in plastic water bottles that have BPA in them. That acts as an estrogen that’s then getting metabolized by your gut microbiome. Your gut microbiome can actually work in your favor by metabolizing the estrogen in a way that it gets pooped out of your body, where it can actually allow that estrogen to get absorbed into your body and make you estrogen dominant. Then you’re wondering, “Why can’t I get pregnant,” where you’ve got hormonal imbalances, and the gut is one key aspect of that balance that is really important when you’re thinking about preconception planning.

Dr. Pedre:                           How do you eat? How do you eat if you want to get pregnant? You’re thinking about, “I want to have a healthy gut.” Well, you want to increase your fiber. When you’re increasing fiber, and that can be dark leafy greens. That could be oats. That could be also buckwheat. It can also be adding in garlic, onions, Jerusalem artichoke, dandelion greens, blueberries, bananas. You also want to add in fermented foods as well. Sprinkle those into your diet. The authors of this study were asked, “What do you think? What is the best diet for gut health?” The study authors thought, “If we continued this for longer.” He thinks, “Probably the answer is in the middle, and it’s really a hybrid diet.”

Dr. Pedre:                           How elucidating, that first study ever to show the difference between a high fiber and a high fermented food diet, and what that can do for microbial diversity and inflammatory markers. You want inflammation to be down. One of the things, if someone is having difficulty with conception, you always want to look at the gut, because if a woman’s body is inflamed, then the body is going to feel, “This is not a safe place for me to hold a baby.” It’s not going to want to hold a baby until that inflammation is down. Our biggest potential avenue for inflammation is the gut, and the foods we eat, the things we’re exposed to through the gut lining. Then, of course, gut permeability and the exposure to things that live in the gut, like endotoxin from gram negative bacteria.

Dr. Carrasco:                      I think something that maybe people don’t often think about is that, when you give birth to a baby, that baby is going to basically swallow your poop. They’re going to get-

Dr. Pedre:                           They’re going to get your microbiome.

Dr. Carrasco:                      They’re going to get your microbiome.

Dr. Pedre:                           That’s why it’s-

Dr. Carrasco:                      As they come through the birth canal. Exactly.

Dr. Pedre:                           That’s why it’s so important to think about when you’re thinking about preconception planning. Also, that your gut microbiome dictates the microbiome inside the vagina, which is what the baby is going to be exposed to when it exits your body. That’s a very important part of the almost colonization of the baby’s body with bacteria that are going to play really important and significant roles in the health of that baby, going into teenage years, including the risk for allergies and asthma.

Dr. Carrasco:                      Absolutely, and autoimmune disease.

Dr. Pedre:                           They go up in c-section babies. If you’re not breastfed, as well.

Dr. Maren:                          You know what I wonder, though, is if you’re inheriting your mom’s microbiome, and mom has a lot of dysbiosis. Is there a time when c-section might actually be favorable for that kid? I don’t know. This is purely a question. Nobody has studied it, right? I have to wonder about that, if a mom has massive yeast overgrowth, or something like that.

Dr. Pedre:                           Yeah. That’s a really good question. Yeah. I don’t know.

Dr. Maren:                          That’s one we don’t know.

Dr. Pedre:                           I don’t know if that’s been studied.

Dr. Maren:                          No.

Dr. Pedre:                           When you have a c-section, what happens is the baby gets colonized with the skin microbiome first.

Dr. Maren:                          Right.

Dr. Pedre:                           The gut microbiome takes longer. Now, if you have c-section and then breastfeed, at least you’re getting the human milk oligosaccharides.

Dr. Carrasco:                      That’s right.

Dr. Pedre:                           The baby is going to be able to build up that very important bifido infantis, which is a really key part of keeping the gut healthy in the early years.

Dr. Maren:                          Yeah. I think back. We talked about where you just talked about fermented foods. So many of my patients who have underlying digestive issues, they don’t tolerate fermented.

Dr. Pedre:                           Can’t tolerate them.

Dr. Maren:                          Histamine issues. They get migraines. They’ve got bacterial overgrowth. Probiotics make them feel worse. Fiber makes them feel worse. They can’t eat anything. They can’t eat garlic or onions.

Dr. Pedre:                           Even just saying that, you realize … to think about that, that you’re saying most of your patients have this. That preconception planning should really start a year ahead, because you need to unravel these issues. You’ve to unpack all that stuff, and you’ve got to start working on it, reestablishing microbial balance, and getting them to the point where they can tolerate having some fermented foods. For anything like this, when you’re increasing ferments, or you’re increasing fiber, people should start really small.

Dr. Pedre:                           I was actually interviewing Summer Bock, the fermentationist, for my second book. She was telling me that she’ll start people at a quarter teaspoon of a ferment. That small to test them out, and then go from a quarter to a half teaspoon, to three quarters, to a teaspoon, but not got really fast too soon, because you don’t know how this person’s individual system is going to react to these ferments.

Dr. Carrasco:                      Yeah. I think with the GAPS diet they’ll do-

Dr. Maren:                          It’s like women-

Dr. Carrasco:                      The liquid rather than the actual vegetable, the fermented vegetable, often. You know? [crosstalk 00:23:39]

Dr. Pedre:                           Yeah. In the GAPS diet, people make their own homemade yogurt, which I think is so much healthier to do. You can make your own homemade kefir, but you have to start small.

Dr. Maren:                          It’s the upstream stuff, like for women who have UTIs, or get sinusitis every year. You really got to start back there so you don’t just keep going on antibiotics and backtrack. If women are struggling with recurrent stuff, it’s really you’ve got to cultivate your health first, if you have the opportunity to do that. Right?

Dr. Pedre:                           I’ve seen so many women who get recurrent yeast infections. Their doctors are just okay with giving them Diflucan every couple of months. My point of view is, well, the reason you’re getting it is because you have a reservoir of yeast in your gut. We need to fix the actual root of the problem, which is in your digestive system, and get rid of the yeast there. Reestablish balance so that the probiotic bacteria keep the yeast in check, and then you don’t have to keep going on rounds of Diflucan, or whatever antifungal.

Dr. Carrasco:                      What are some of the most common patterns that might present for people when they’re dealing with gut issues? I know that you talked about specific symptoms, but just digestive. I guess more digestive symptoms. What are some of the things that might show up?

Dr. Pedre:                           Number one is bloating. That is the number one complaint. People might think that all bloating is the same, but depending on when the bloating happens, the bloating can mean different things. If you get bloated as soon as you eat, then that can be a sign that you’re not producing enough enzymes in the stomach, and that you’re also not producing enough stomach acid. That would be bloating that starts, and you might even start burping. People have low stomach acid. They’ll eat, and they might start burping right after they eat. That’s a sign that maybe they’re not making enough stomach acid.

Dr. Pedre:                           Another sign is food feels like it doesn’t empty the stomach. You eat a rich dinner. Maybe you have protein, and it sits in your stomach for like an hour, two hours, and it just feels like it’s not moving. It’s like a brick in your stomach. Those are signs of upper digestive issues. Then bloating can also come 40 minutes after you eat, an hour after you eat. Maybe two hours after a person eats. Depending on what their bowel transit time is, that can be a sign of small intestinal bacterial overgrowth, bloating that starts a little bit later. It can also be a sign of leaky gut as well. A lot of times these things go together.

Dr. Pedre:                           It’s really easy when people present with abdominal complaints, because it’s very clear. Okay, they’ve got something going on with their digestive system. It’s a little bit tougher when they don’t come in with a lot of digestive complaints, but they’re tired. They get migraines. Maybe they get achy joints. They’re breaking out in hives, or they have eczema, or they have some patches of psoriasis. You know that all of this is connected to gut health, but they don’t necessarily have to present with a gut health issue. Maybe they have autoimmune thyroiditis, Hashimoto’s. Autoimmune disease is also connected to leaky gut and gut permeability issues, so not all of the reasons are obvious.

Dr. Pedre:                           A lot of times, patients will go into a doctor and say, “I’m experiencing these symptoms.” If they go to a regular Western doctor, they might get medications to treat the symptoms, without understanding that the symptom isn’t really coming from where the symptom is. It’s actually coming from an underlying root cause, which is tied to the gut. You have to look in the gut. What’s always surprised me is when you do gut testing on a patient that has no gut issues whatsoever, and yet they have a lot of what I call gut related health issues. You see it come back with parasites. You see yeast overgrowth. Then you fix that and their other symptoms at least drop by 50%, if not completely disappear.

Dr. Carrasco:                      Do you like PCR testing?

Dr. Pedre:                           I honestly think it’s the best that we have right now. There’s a lot of different types of PCR tests. There’s 16S RNA. That one is a little more limited, because it only looks at 10,000 different strains. There’s also whole genome sequencing, and that gives you the whole array of what’s in there. The problem is that one study looked at taking aspirates from different levels of the gut and running PCR on all the different aspirates. What they found is that the stool is really good at telling you what’s in the stool. It’s not really good at telling you what’s higher up, like in the small bowel, or in the duodenum, which is really high up near the stomach. We have to take it with a grain of salt.

Dr. Pedre:                           What I really like, in terms of looking at a stool study and getting a whole array of bacteria in there, it’s telling you, “These are high and these are low.” I think we still have a ways to come before we can really say that’s a diagnostic tool, but we can look at the patterns, and maybe see. Well, maybe there are certain patterns, combinations, that go with certain diseases. You can certainly look for parasites. You can look for worms. What I think is also really helpful from these functional stool studies is looking at the inflammatory markers, like calprotectin, lactoferrin. Also looking at secretory IGA. Looking at zonulin, even though I know zonulin in the stool is controversial if it’s not elevated.

Dr. Pedre:                           For anybody who’s listening, zonulin is basically a chemical messenger that controls the permeability of your gut. If zonulin is high, it’s telling your gut to become more permeable. Theoretically, if there’s a lot of zonulin in the stool, then you’re producing too much zonulin, but that’s not a black and white situation. If zonulin is low in a stool test, it doesn’t mean that you don’t have leaky gut or increased permeability. When it’s high, it’s kind of nice. You can say, “Oh, your zonulin is high. You’ve got leaky gut,” but if it isn’t, you may still have leaky gut.

Dr. Pedre:                           Stool studies to me are like a Monet painting. They’re kind of blurry. They give you some idea of what you’re looking at. You know you’re looking at water lilies, but they’re not in full crystal clear Kodak picture color. They’re a little blurry. Stool study is giving you a view into your gut, but it’s not perfect. That’s where medicine is really truly an art, and you have to match the study to the patient and understand what is it that they’re feeling, and … make sure that it’s consistent with what’s going on. Say the stool study doesn’t have yeast, but your patient is presenting with a lot of sugar cravings, and itchiness, vaginal itch, so signs of yeast overgrowth. You treat the person in front of you. That’s why it’s so important for anyone who’s listening to this to think about that you really need to find a doctor that will listen to you. It’s not just about treating numbers from a test. You’ve got to treat the person.

Dr. Maren:                          I agree with you. The stool testing is helpful, but it’s not perfect. We just have to realize there are some shortcomings. Sometimes we get false negatives. Sometimes we get false positives. I think the more tests you see, the more that you kind of realize that. What are your thoughts on OATs, or organic acid testing? Do you find that helpful for sometimes diagnosing upper gut stuff?

Dr. Pedre:                           I also like looking at it, and definitely like looking at certain metabolites, like the arabinose, as a potential way to diagnose yeast overgrowth. There’s other metabolites there that could go with other types of yeast, aside from candida. You can also diagnose … I think it’s called HPPA, which is a metabolite from clostridia. I had one patient, at least, where she had become really anxious. She had an elevated HPPA. We actually treated her with an antimicrobial for clostridia, and her symptoms improved right away. It was kind of an odd thing, but quite fascinating to find. You read it in textbooks, and then you see it in the patient, so-

Dr. Maren:                          What did you get, dopamine metabolites? Which did you find?

Dr. Pedre:                           Yeah. It’s in that metabolism. Yeah. It blocks one of the-

Dr. Maren:                          It’s super interesting, huh?

Dr. Pedre:                           It blocks one of the enzymes. Again, just like a stool test, it’s like you’re putting these transparencies over each other. You’re interlaying them, but what’s at the bottom of that transparency is the patient.

Dr. Maren:                          Right.

Dr. Carrasco:                      Yeah.

Dr. Pedre:                           You’re always, always looking at the patient, and you’re overlaying all of these different tests and seeing, “Okay, does this fit? Does this match?” What I’ve actually become much more careful about is being aggressive with my treatments. I’ve actually become much gentler with gut treatments over the years. I used to, in the early stages, say, “Okay, they’ve got this overgrowth. I’m going to give them an antibiotic. We’re going to wipe this out, then I’m going to bring in probiotics.” Now, I try to use more natural means and be a bit more careful about how to treat these things. Really looking for underlying causes. Making sure they’re having daily bowel movements, which is really important, especially with small intestinal bacterial overgrowth. If they have problems with the rhythmic contractions of the intestine, trying to figure out ways to reengage that. Looking at the root of the root. Is this a stressed out type A person who’s rushing through their lunch while at work? Is this a mom with three kids? Guilty as charge. Is this a-

Dr. Maren:                          I’m hiding back here.

Dr. Pedre:                           Is this a mom with three kids who’s taking care of everybody else but themselves? It really goes back to knowing who the patient is, and making sure that you’re not overlooking. Just because you can give them the right diet, the right supplements, the right probiotic, don’t overlook the fact that this is a stressed out person. If you don’t change that, you’re not changing the primary factor that has played the key role in why they ended up where they’re at.

Dr. Maren:                          Yeah. It’s pretty much the same as the person who goes on antibiotics every season for recurrent sinus stuff. You’ve got to treat the upstream issues or things just come back around. Of course, the more you work on gut stuff, I think it’s a bit of a vicious cycle. Right? Because you’re probably less prone to getting sinusitis once you’ve fixed your gut microbiome and fix your immune system a little bit.

Dr. Pedre:                           Yeah. If you fix the stress stuff, and bring in self care, then with self care comes better choices on what to eat. Emotional eating goes out. It’s easier to make the right choices for oneself, so it’s all-

Dr. Carrasco:                      Can you talk about-

Dr. Pedre:                           All interconnected.

Dr. Carrasco:                      Can you talk a little bit about why stress affects the gut, and how cortisol affects the gut lining?

Dr. Pedre:                           Well, cortisol is like an attack on the gut, so it increases gut permeability. High cortisol will actually cause alterations in the gut microbiome, and, because it raises blood sugar, can then lead to yeast overgrowth in the gut. For anybody who has high cortisol, what happens is you’re kind of in a fight or flight reaction, but you’re in chronic stress. It never turns off, so your body then starts to change and adapt to that situation. Eventually it just causes alterations in the gut microbiome that lead to increasing intestinal permeability. That is the avenue to inflammation, and opens up the door to many things, including the possibility of autoimmune disease, which Alessio Fasano said takes three factors: genetics, and environmental input, and leaky gut. When you have those three things together, then your chances of getting an autoimmune disease markedly go up.

Dr. Maren:                          Yeah, that’s how it works.

Dr. Carrasco:                      What are some of your favorite ways to kind of modulate that cortisol response? Especially given where we are kind of in history right now, because I think the last two years have been very hard for most people.

Dr. Pedre:                           Yeah. It’s really things that can help rebalance the parasympathetic and sympathetic nervous systems. The sympathetic is the fight or flight. The parasympathetic is the rest and digest. Part of the way that we can really oppose cortisol is by increasing oxytocin. Oxytocin is the direct antagonist to cortisol. It’s the antidote, really. Things that you enjoy doing. If you enjoy dancing, put on music and dance. If you enjoy painting. Hobbies. All of those things can increase oxytocin. Of course, relationships. Having sex. When you orgasm, that’s the strongest release of oxytocin. It’s so healing for the body. I think women need to orgasm just as much as men need to orgasm to be able to keep that balance. Even just getting out in nature. Going out to the seashore. Getting out to a waterfall, to a moving river. All of those things help increase oxytocin and lower cortisol levels.

Dr. Pedre:                           Then meditation. I think it’s so important. Any meditative practice. It could be yoga. It could be Tai chi, qi gong. It could also be playing an instrument. For me, my meditation is sometimes getting on the piano, and playing the piano. I’ve just recently started doing that again. I can find that I’ll sit on the piano, and then the next thing I know an hour passed by. I’m like, “Wait. How did that happen?” You get into a zone. You get into flow. All of those things, they help alter your cortisol levels. They create more happiness within your body. The more that you can create that feeling of safety in the body, the better that your body can manage stress, and the ability to be resilient with stress, to have a stress, but also be able to bounce back into more of that rest and digest part of the nervous system.

Dr. Carrasco:                      Yeah. That’s really great info. Something that I started doing after my 40th birthday is I started rollerskating, because I didn’t feel like I was ever having any fun. I feel like a kid when I do it, and then also time goes by really fast. I think it creates a flow state for me, and it’s incredibly joyful. I think a lot of-

Dr. Pedre:                           Yeah. I was going to say that reminds me of-

Dr. Carrasco:                      A lot of adult stuff-

Dr. Pedre:                           Bringing laughter in. Being like a child. Laughter. Again, another great antidote. When I have patients who are completely paralyzed by stress, they’re like, “I’m so anxious. I can’t do anything.” I tell them, “Go on YouTube and look up something funny. Just start watching funny videos, or watch a comedy. Just make yourself laugh. Do things that are lighthearted that can get your mind off of your constant state of stress.”

Dr. Maren:                          It’s like the social aspect in the last couple of years … It’s better a little bit now, but so many of us have been so isolated, and away from our friends, and going out with friends, and laughing, and going out to dinner, and just some of those. That’s what I think of when I think of some of my joyful moments with girlfriends. It’s like-

Dr. Pedre:                           Look-

Dr. Maren:                          That disappeared from our life.

Dr. Carrasco:                      Totally.

Dr. Pedre:                           Look what happened as a result of that forced isolation, the lockdowns we had. Suicide rates went up. Domestic violence went up by a lot. I think the rate of domestic violence doubled. It’s not healthy for us to be isolated. I mean, humans are pack animals. We’re social. We’re community, and especially for women. Compared to men, I think they found that men will live longer if they’re at least in one important significant relationship. Whereas, women, they kind of need a group. If they have their group of friends, very significant friends that feed their soul, then women tend to live longer. Whereas, men, they just need one person. If they’re in a good relationship, they will live longer with having the relationship with that one person.

Dr. Carrasco:                      There’s some pretty interesting anthropological studies on tribes. The men would typically go hunt and gather for two to three hours, or they would hunt for two to three hours a day. The rest of the day would be spent lounging with their kind of male compatriots. Then, in the females, they would maybe gather and produce food for, again, another two to three hours. The rest of the day was childcare and community … I think just the-

Dr. Pedre:                           And laughter.

Dr. Carrasco:                      Yeah, and laughter.

Dr. Pedre:                           And laughter. I saw that when I went to Africa last year before the world shut down. I stayed with the Hadza, the hunter gatherers. They’re one of the last hunter gatherer tribes on the planet. Very true. The men would huddle together in a cave, and that was the men’s cave. Man cave. Funny. The women were separate, and they were doing things like making things, clothes, hanging out, talking, laughing. They were with the children. The men would go out hunting. We had the chance to do that. They would go hunting and gathering while the women stayed behind and did other chores and things. It’s really interesting how, in Africa, there’s this delineation in tribes.

Dr. Pedre:                           I also stayed with the Maasai people. When I was with them, I learned that it was the women who actually build the houses out of cow dung and dirt, like sand. The men tend to the sheep and the cattle, or the goats. They don’t build the houses, but it makes sense. If the woman is kind of the homemaker, they’re the ones who build these. They were quite sturdy structures, and they did not look easy to build. Just thinking that it was the women who build the homes.

Dr. Carrasco:                      The heart of the home. Yeah.

Dr. Pedre:                           Yeah.

Dr. Maren:                          Wow.

Dr. Carrasco:                      That’s amazing.

Dr. Maren:                          I wonder what that did to their microbiome diversity.

Dr. Carrasco:                      Yeah. I wonder what happened to your microbiome in your travels, because haven’t there been people that have gone out with those two tribes, and their microbiome changes within the week?

Dr. Pedre:                           Yes. Yeah. I know my friend Eric [Amidees 00:44:09]. He spent multiple times with them. Just being out in nature, I think that’s one of those things. I was thinking of you, Alejandra, with your garden, because that’s another stress reliever is just spending time out in nature, getting your hands dirty in the soil.

Dr. Carrasco:                      So true.

Dr. Pedre:                           That’s also a way to enhance your microbiome. The Hadza, the hunter gatherers, have one of the most diverse gut microbiomes on the planet. Partly, I think, because they haven’t been exposed to antibiotics, but also because they’re out in nature, and they’re getting exposed to all sorts of things. They’re not washing their hands. They’re not overly hygienic like we’ve become. I think it’s a really important part of microbial diversity. I know I started talking about that in that study about the high fiber fermented foods diet. Well, one study they haven’t done is they should throw in an arm where people don’t eat high fermented foods or high fiber, but they get out in nature and they get their hands dirty. It’d be interesting to see who ends up with the most diverse gut microbiome from those.

Dr. Carrasco:                      That’d be a great study.

Dr. Pedre:                           Especially if you have an organic garden, and you grow vegetables, and you eat the vegetables from your garden.

Dr. Carrasco:                      Yeah. Okay, one last question for you. We could have you on several more times to dive deep into gut health. I think, for our preconception health audience, what are some of your favorite supplements that they could start taking as they work to build a healthy gut?

Dr. Pedre:                           I always think a probiotic can be essential, even just in the beginning when someone’s experimenting and working on changing the diet, but while their diet isn’t exactly perfect yet. They can go for a multi-strain probiotic. Depending on what the underlying issue is you have to be careful, because if someone is already suffering from bloating, then you have to be really careful about the type of probiotic that is used. It might be better to use a spore based probiotic in those instances, or a soil based probiotic, because those tend to do better in patients or people that have a lot of bloating that could be related to small intestinal bacterial overgrowth. If you don’t have bloating, and you want to try starting with a probiotic, always start low with like 30 billion, 20 billion CFUs. Then you can work your way up. 50 billion. Maybe max 100 billion. They’re finding now that you don’t have to do those. You might not have to do those really, really high CFU count probiotics.

Dr. Pedre:                           What’s really interesting, I was at a conference with Dr. Bland. He presented a paper. I think it was on fecal transplant, and giving fecal transplant capsules, but the fecal transplant was actually heated so the bacteria were dead in the capsule. They weren’t alive anymore. They still had a positive effect.

Dr. Carrasco:                      Interesting.

Dr. Pedre:                           The question was, are there other factors aside from the living organism that has some sort of modulatory effect on the other bacteria that are living in the gut? Because we always think it’s the live organism that has a factor, but it could be not the living organism. Maybe it’s just the types of bacteria that are represented. We were talking about supplements for gut health. Maybe also a leaky gut formula, or a formula that’s designed to support the gut lining with nutrients like glutamine, quercetin. Maybe some prebiotic. Arabinogalactan. Not too much. Slippery elm bark. Marshmallow root extract. Things that we know are soothing for the gut. DGL, deglycyrrhizinated licorice. Aloe vera as well. There are really great combination powders out there that can be really helpful for that. I’ve helped design at least one of them, but there’s a lot of different brands that produce these powders. I don’t know if you want me to say a brand, or just-

Dr. Carrasco:                      That’s fine. I’m okay with it.

Dr. Maren:                          Yeah. I think our listeners will like that.

Dr. Pedre:                           Yeah? The one that I feel very proud of because I helped in creating this formula is Nature MD’s Gut Connect 365. That’s one thing. It’s important to know, for anyone who tries a probiotic, or any healing powder. If it doesn’t work, it doesn’t mean that all probiotics are bad for them. It just means that that particular formula maybe isn’t the right formula for them. Really, just thinking about the diet. Incorporating fiber. We talked about fermented foods, but testing them out little by little. Not starting out with a whole quarter cup of sauerkraut every day, which is probably close to what I eat when I have sauerkraut at home. One of my favorite things to put on my gluten free toast with a pasture raised egg. If I don’t have avocado, I put sauerkraut on top.

Dr. Carrasco:                      That sounds pretty good.

Dr. Maren:                          Yeah. That sounds really good.

Dr. Carrasco:                      Yeah. We’ve been getting some really great fermented pickles. It’s been making our pasture raised burgers pretty excellent.

Dr. Pedre:                           Nice.

Dr. Carrasco:                      Yeah. Well, I’m so thankful that you came on the show, and that you have shared all your wisdom with our audience. I really recommend to our listeners that you read Dr. Pedre’s book, Happy Gut. It’s a wealth of information. He goes super into depth, basically regarding every aspect of gut health. I think that’s a really great guide. Will you tell us where people can find you? You’ve got a really robust Instagram platform.

Dr. Pedre:                           Yeah. I’m on Instagram at Dr. Pedre. That’s probably my most active social platform right now. I’m also on Facebook at Dr. Vincent Pedre. They can learn more about me by going to HappyGutLife.com. I put a lot of free information there, including blog posts on different topics. October is breast health month, so we’ve put out some topics on women’s health, on estrogen dominance, and things like that. I also have a free giveaway for your audience.

Dr. Carrasco:                      Tell us more.

Dr. Pedre:                           It’s called my Top 10 Tips for a Healthy Happy Gut. It’s basically the Cliff Notes to my book, Happy Gut, so if you don’t have time to read the whole book, then just get the download for free. I think you’ll put it in the show notes. Right?

Dr. Carrasco:                      Yeah. We’ll put it in the show notes. We’ll put it.

Dr. Pedre:                           Yeah, so you’ll put the link there. It’s basically my best tips for how to achieve and maintain a healthy happy gut. It’s just rich with information, including, I think, we even have some recipes in there as ideas for people to try out.

Dr. Carrasco:                      That’s awesome. Well, thank you once again. We’re definitely going to be asking you to return in the future, so I hope you’ll join us again.

Dr. Pedre:                           Of course. Thank you for having me.

Dr. Carrasco:                      Thank you.

Dr. Pedre:                           Finally. It took a little while for us to coordinate this.

Dr. Carrasco:                      I’m so glad. All right.

Dr. Maren:                          Thanks, Vincent.

Dr. Carrasco:                      Thanks so much, Dr. Pedre.

Alejandra Carrasco M.D. and Christine Maren D.O.

Hello! We are Alejandra Carrasco M.D. and Christine Maren D.O. We founded Hey Mami because we felt a lack of support for fellow mamis. As physicians, we see women every day who struggle with fertility, are forgotten about postpartum, and have put their health on hold for years while they raise a family. We’re here to change that.

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