All language subtitles for Interconnected – Episode 7

(upbeat music)

- Welcome back.

This is Dr. Pedram Shojai, the urban monk,

here again hosting this
wonderful experience

called INTERCONNECTED.

I had the privilege of being in a room

with all the healthcare
professionals and patients

you've been hearing from.

And this groundbreaking
information can save your life.

We ask that you share it far and wide.

It takes around 15 years for
new medical breakthroughs

to reach most doctor's offices.

That means whatever health issues

your eight year old daughter is having,

your family doctor may not
offer the latest treatment

until she's a full grown adult.

We simply can't wait for the
slow turning wheel of medicine

to catch up to the science.

In our first segment
we're gonna talk about

the microbiome's role in
the detection, prevention,

and possible treatment of cancer.

This is revolutionary stuff.

It is rocking the foundations of medicine.

See for yourself.

- You know, back in they late 2000s

people started to ask the question,

I wonder if we can find
bacterial DNA in normal tissues.

Because we were at this time
seeing huge correlations

between what is the microbiome in the gut

and what is the cancer
that patient ends up with.

And that, for a former
chemotherapy researcher,

was very hard to swallow,

that cancer could somehow be predicted

by which microbiome were in the gut,

and you could figure out

if they were gonna have
breast cancer or not.

That just didn't make any sense

with the model that we still
have to this day of cancer.

And so around that 2007, 2010
time was an exciting time

where technology was starting to allow us

to ask the question and get some answers

and the bulk of these disease epidemics

was demanding that the questions be asked.

Have we done something to
the greater environment

to suddenly cause all of these

seemingly disparate disease processes

all go epidemic at once?

And so, as we started to
untease the microbiome question

we started to find that if
you biopsy normal tissue,

you find bacteria in there.

If you biopsy cancer tissue

you see different bacteria in there.

And so that was a big, big shift.

One of the recent ones that
got published around 2014

showed that healthy breast tissue

has bacteria that's enriched
in it called sphingomonas.

It's a cousin to pseudomonas,
which we see as kind of

a dangerous pathogen in the hospitals.

So to find out that
sphingomonas actually lives in

the healthy breast of women
was a little bit jaw dropping.

They then biopsied the other
breast that had cancer in it

and they found that there was
almost no sphingomonas in it

but there was this methylobacterium there,

a totally different species,

enriched within the tumor tissue.

This started to ask the question,

I wonder if cancer is actually
an infectious disease.

And what if the wrong
bacteria moves into the breast

starts to cause a dissolution

of the function of the tissue or something

and starts to cause cancer.

These benign cancers
that never really grow

were rich in methylobacterium.

The aggressive cancers that kill

the women who go metastatic,

everything else, these have
no bacteria left in them.

And so a stunning realization of

the human body should
be an organic garden.

And as we kill it,

through our environment, through
our medical interventions,

we get more and more stale.

It starts to lose its identity
as human as it gets isolated.

And we definitely see
this on the macro level.

One of the most potent
punishments that's ever been

come up with in the history
of human is isolation.

So we do these prison cells
that we isolate prisoners.

and they go through sensory deprivation.

And everybody, no matter how intelligent,

no matter how damaged,
no matter how intact,

will start to hallucinate
by day three of isolation.

And so, this is very much
what happens to a cancer cell.

Put it in isolation.

You put that, any cell in the
body into solitary confinement

and it has no ecosystem,
no garden around it,

it's gonna turn into cancer.

- What I find really
intriguing is the idea that

there have been some reports now

that some of these
microbes in various tissues

are associated with various
diseases or specific cancers.

I think we have to be careful

because we're still in
a phase of the research

where what's been reported
represent associations,

and we haven't yet been able
to show cause and effect.

However, that possibility
absolutely exists.

And if that is true,
and I'm not gonna say,

I'm not gonna go so far as to say

it will be true in all
instances of breast cancer,

or pancreatic cancer,
but if it is true in some

then what that may potentially provide us

is a completely new set of targets

to begin to think about
treating some of these diseases.

- I have a lot of patients
that have the BRCA gene,

the breast cancer gene,

that are BRCA positive,

but they haven't yet developed a cancer.

And what the conventional approach is

is that in women that have
completed their families

that they recommend that
the ovaries come out,

and they recommend mastectomy

whenever the patient decides
that they want to have that

often significant reduction
of breast cancer risk.

So patients come to me

because they want to
know what else can I do

other than surgery.

And straight off the bat I want to say

it's not that I'm opposed to the surgery.

I think the surgery is a great thing

for someone that wants a
significant risk reduction

and actually can embrace

and feels good about having the surgery.

And then at the same time I'm a resource

for those patients that have
already decided themselves

that they don't want to have the surgery

and want to know what else can they do.

In addition, as an OB-GYN,

I'm usually the primary care
provider for my patients,

so I'm the one that notices

that they've got this
strong family history,

and I'm the one that does
the initial BRCA testing.

So I can think of one
patient, her name is Cathy,

and she came in for a routine annual exam,

new patient exam.

And part of that evaluation
is a family history.

I found out that she
had a mother, an aunt,

both with breast cancer under age 50,

and she was Ashkenazi Jewish,

which put her at risk for
having this breast cancer gene.

She really didn't want
to have testing done,

and I told her that I was
okay with whatever she did

but just realize that
sitting here right now,

in my office, you either
have the gene or you don't,

so that's already determined.

So if this gene is already in your body

why not know about it so
we can start to do things

so that we can reduce the chances

that it will express itself.

And that was the argument that swayed her.

And so, we did the test,

and unfortunately it came back positive.

And she had two young
kids at home, 16, 12.

And she really said, I have
to be alive for my kids.

And she really wanted the surgery.

However, she also wanted to do things

in addition to the surgery.

And so the first thing
we did was gut health.

We found the foods that
she was sensitive to,

so the foods that she shouldn't be eating.

And we really did only one thing at a time

from a functional perspective

because so much was going
on with the surgeries.

We picked that one intervention

and then all of sudden
she said, do you know,

I'm a little less anxious,

because she had a little bit
of a baseline anxiety issue,

and I haven't gotten any migraines

ever since I stopped
having dairy and gluten,

which she was coincidentally sensitive to.

And so right away I said that's great,

and you know that by decreasing

the inflammation in your body

from the gluten and the dairy

you're also helping yourself

in terms of reducing the
likelihood that this BRCA cancer,

this BRCA gene will turn
into a breast cancer.

- The current model that I think

we have to really start
to come to terms with

as medical scientists
is that it's no longer

the understanding that
it was a genetic injury

that led to all this
proliferative behavior

because we turned on the wrong genes

and we turned off the genes

that would have protected us from it.

That's happening,

but to give you a sense of

how damaged these cancer cells are,

we do this in our own clinic.

So, we'll get a cancer
patient with a weird cancer

that's not behaving like
we expect with treatment,

and we can actually put that
in the culture and grow it up,

and we can then do genomics
on that tumor cell.

At that point, the cell is
so damaged it can't repair.

And the more I've learned
in the last seven years

of starting understanding
cancer in the context

of the microbiome I started to realize,

these cancer cells are
simply just so damaged,

and they're so isolated,

that they've come to do
the only thing they can do.

They think they're the
only thing left of life.

They have completely forgotten

they were part of a larger organism,

so this is the dream of their
own that they started to dream

of I can't repair anymore and
the only thing I've got left,

the only option is to divide.

And so these cells start to go

into cell division very quickly.

And that's the biochemistry
or the cell biology of cancer

is rapid cell division.

With every division they're passing on

all the damaged genetic information

and so none of those progeny
can repair themselves either.

- If I had a BRCA gene,
if a woman had BRCA gene,

how could you use the
microbiome's ecosystem

to help it not express?

Like, do we understand this well enough

to know how well they work?

It feels like we don't, so
we just hack out the parts.

- The question about whether we can use

our understanding of the microbiome

to affect gene expression
of a gene like BRCA

is really where the rubber is
meeting the road right now.

And this is really so exciting.

So we know with BRCA, for example,

that in patients that are BRCA positive

they don't metabolize or digest
estrogen in a healthy way,

that they are more likely
to produce estrogens

that can destroy DNA in
the breast, for example.

When we look at the microbiome

we know that the microbiome determines,

or is one determinant,

of the way we excrete, or
digest, or metabolize estrogen.

So a BRCA patient who is predisposed

to metabolizing estrogen in a healthy way

can either be hurt by her microbiome

if her bugs are continuing to facilitate

an unhealthy estrogen metabolism,

or she can be helped by her microbiome

if her microbiome is structured such

that it can be beneficial
with estrogen metabolism.

And that's my role,

to understand the science
in both of these areas

and then to know what I need
to do to help the microbiome

so that her estrogen metabolism

is made to be as healthy as possible.

That's really the juice
in what I do right now

and that's why I love being
here to talk about this topic,

because really, just in summary
here about the microbiome,

the way we can tweak it

is not only by avoiding foods
that we're sensitive to.

It's eating foods that are
high in prebiotics rather.

So it's about what we feed our bacteria

I think might ultimately be more important

than the actual bacteria that are there,

but that has yet to be proven.

So the food that we feed our bacteria

clearly is the same food
that we feed ourselves.

And so, prebiotics, which
are primarily fiber,

and then foods that have
fermentation associated with them,

like kombucha, or sauerkraut, kimchi,

those fermented foods are also very good.

And that helps feed,

and therefore sustain, the right bacteria.

Then you do a microbiome analysis

and you see what's there
or what's not there,

and you give probiotics
to make sure that you are

giving the right strand of bacteria,

the right type of bacteria.

Then you feed the bacteria properly

and that I think is really
where all health is going.

- We've got oncologists
that are telling people,

don't eat blueberries.

Don't eat blueberries because
blueberries have antioxidants

and that's gonna interfere
with the chemotherapy.

That's nonsense.

If you don't make the person stronger

then how are they ever
gonna fight this thing?

So it's a combination.

You've got to go after the
bad guys, the bad cancer,

but you've got to make the
person strong at the same time.

- So, people often ask
me why I don't recommend

that they eat any sugar
if they have cancer.

And the answer is a simple one.

Cancer cells love sugar.

We know this because oncologists

use a test called a PET scan

to find active tumor in the body.

And they want to find tumor
that's of small enough volume

that you can't see it on a CAT scan

and you can't see it on an MRI.

So what do they do?

They order a PET scan.

A PET scan leads to the injection
of radioisotope glucose,

or radiolabeled sugar,

because they know that right after

they inject the sugar
into your bloodstream

it goes straight to the tumor.

And so then they put
you through the scanner

and they see where that
radiolabeled sugar went.

So even the doctors know

that sugar goes straight to cancer,

but that doesn't translate

into a recommendation to avoid sugar.

Sugar also happens to be
horrible for your microbiome.

The bacteria that eat sugar

are the ones that cause inflammation,

both locally in your intestinal tract

and systemically through
the rest of your body.

So sugar feeds not only the cancer cells

but the horrible bacteria in your gut

so stay away from sugar.

- Have you seen any positive
signal on cancer cells

kind of joining back with the
tribe when given the milieu?

- Cancer is actually the weakest,

most lonely cell in your body.

And out of that we've built
a $450 billion a year medical

intervention called
chemotherapy, surgery, radiation

that has nothing to do
with getting the cell

back into awareness of
its greater environment.

We can equate this back to

the solitary confinement
that we do to prisoners,

but we also do this to our psych wards.

And so, when somebody goes psychotic

we tend to put them in
an isolation chamber,

put them in a straight jacket,
or put them in a padded room

and they beat the crap out
of themselves for a few days

while really what would be ideal

is surround that person with
so much love and nurture

that they have no choice but to connect

into the larger organism again.

And we do the same thing
to our cancer patients.

We put them in hospital rooms
that have now been sterilized

from any microbiome whatsoever,
stick them in a room,

give them tons of chemotherapy
to completely annihilate

their immune system and their microbiome

and then hope they survive
this symptom of isolation

on top of their disease process.

- It's the best we got right now.

I mean, I've seen people
say, I'm not gonna do that,

and then watch them fall apart.

I'm not a fan of it,

but I've seen it work for enough people

that are still alive 15, 20 years later.

So yeah, I'm not gonna
knock it when you need it.

My argument is integrative medicine,

like why can't you have
them getting acupuncture,

and doing mindfulness meditation,

and taking probiotics and antioxidants,

and eating broccoli and things like that.

There's cells called
dendritic cells, for example.

They send out these little periscopes,

and they're sampling everything we eat.

They know exactly what's going on.

They know exactly the kind of balances

or imbalances that we have
in our gut microbiome.

And then, I hate to use this word,

they choose how they're gonna response.

And it's not really magic.

It seems kind of magical

but if a dendritic cell sees a probiotic

like Lactobacillus acidophilus

there's a kind of molecular
signal that that dendritic cell

gets from that Lactobacillus acidophilus

that actually programs the
DNA of the dendritic cell.

And then that dendritic cell

sends out messages to
lymphocytes and says,

okay, you can be assured that
this guy is not a problem.

Be cool.

- And so, our medical practice,
our medical interventions

tend to be isolating just
as our punitive measures do,

in a prison, or in a
psych ward, or any else.

And so, at the cell level

you can almost picture
the same thing happening.

Here's a damaged cell that's
just trying to hang onto life

and all of a sudden it's
getting bombarded with toxicity.

And its tendency is actually
to get more aggressive.

And so one of the things that we do

is measure circulating cancer
cells in the blood stream.

And what we see,

we've seen this in multiple
breast cancer patients

where that circulating amount
of cancer in the blood stream

actually goes up during chemotherapy.

And it almost makes sense.

You just are putting a stressed out cell

that is barely hanging onto life

into a bigger stressed state.

It's gonna do the only
thing that it can do,

which is replicate faster, more
intensely, more desperately.

When you stop the chemo
then you can see that

suddenly settle back down to its baseline

as to where maybe it
was before chemotherapy.

But in the meantime you've
shed cells all over the body

because of the stress
you've put it through.

Contrast this then to

surrounding that person with microbiome.

And we've gotten to see
now some circumstance

where you take somebody who has cancer,

prostrate, breast, doesn't really matter,

and they have circulating cancer cells.

And then you surround their
bloodstream and everything else

with information from the microbiome.

We're not smart enough yet to know

which bacteria need to go into

a system as complex as the microbiome.

However, what we've
decided a safer approach

is to eliminate the bacteria and fungi

and just put their
communication into play.

Because it turns out that
all the species contribute

to a wireless communication network.

If you put that wireless

communication network back into play

you can see the blood sterilize
itself on many occasions.

Which means we've given nothing toxic.

We've just given information
back to the environment

and suddenly you can see the cancer cells

induce cell suicide.

They suddenly realize
life is all around them,

they're part of a larger organism,

and their job now is to
bring in a replacement,

not just to try and survive

as the only isolated thing life.

- Unbelievable.

I'm the last of my species.

I don't see anyone around.

I have no choice but to
replicate aggressively

to survive my species.

Oh no, we're fine.

- Oh, the organism is there.

I'm one of 70 trillion.

There's no expectation
on self to keep going.

- We know the details of exactly

how the DNA is being programmed.

And we know that that message
that goes to the lymphocyte

is a very precise message.

How do we know this?

Because there are actually
drugs that are being used

right now to treat cancer that
can activate that mechanism

where the dendritic cells
talk to the lymphocytes.

There's what's called
co-stimulatory molecules.

This is quite technical.

But those co-stimulatory molecules

come about as a result
of that initial exposure

to the good guy or the bad guy.

Well, the drug companies have found

we can manipulate these
co-stimulatory molecules.

If we turn them on

the lymphocytes suddenly
become very, very aggressive,

and they will kill cancer.

Well that's great if the
person has malignant melanoma

because this could get
rid of their cancer.

But you know what the side
effect of those drugs is?

Autoimmune disease.

What I would submit to you

is that nature's got all this figured out.

Nature's got this figured out.

And when we try to manipulate it,

when we try to fool with it,

we can create a problem.

- I went to undergrad at the
University of Pennsylvania,

and I was lucky enough to
take this course on cancer.

And I wasn't premed at all.

Never thought I'd go to med school.

Wasn't even on my radar.

But I took this really interesting seminar

with Dr. Peter Knowles

who is one of the fathers of genomics

and the relationship
between genetics and cancer.

And it was on the sociology, epidemiology,

and biology of cancer.

And it was all these premeds.

It was this really cool class.

And at the time, my grandmother
was dying of colon cancer.

She had effectively smoked
her way into that disease

and smoked her way into the grave.

Those were in the early days

when people didn't know how
bad cigarettes were for you.

But here's this thing that

you're inhaling through your mouth

that's causing cancer in your colon.

So it's even a few links away.

And now we know that's well established

but for a long time people didn't.

And so it was at that time.

And I ended up writing this
paper during this class

on alternative therapies for cancer.

And I got down this rabbit
hole of research on PubMed,

and looking at the scientific literature,

and looking at all of the
dietary factors for cancer

and the toxic factors for cancer,

like cigarettes, like alcohol,

and getting really mad,
and just being like,

none of this has to happen.

NCI, National Cancer Institute,

50% of cancer at least is preventable

through diet and some
of these other changes.

And yet all of our energy is going towards

these incredibly sophisticated
and often toxic medications

to treat cancer once it's taken hold

and no one is caring about
looking at the whole person

and looking at these other factors

that we actually have a lot of power over.

And so that was kind of the impetus.

And it inspired me, I think,

ultimately to not just pursue medicine

but to think a little bit differently

about what I wanted to do in it.

- The microbiome is like a barometer.

It kind of tells you what's going on.

When the barometer is falling,

that's not what's causing the storm,

that is what is reflecting the storm.

And in that sense, the
microbiome may be useful.

Could be affected by
antibiotics, of course,

but also diet, or different
kinds of food additives,

or the pesticides that
are given to plants,

or even chlorine in water.

There are so many ways in which

we are affecting our microbiome

that we didn't a few hundred years ago.

- We know what we've lost
because you can identify

species that we don't have.

Are there any particular traits

that you're seeing missing on the board?

Like, okay, these bugs are gone,

and these bugs, as far as
we know, did X, Y, and Z.

- The bug that I started
with was Helicobacter pylori,

the bug that was the dominant
organism in the stomach.

And it was discovered in the 19th century

at a time when everybody had it

and then again in the late 20th century

by which time it had disappeared

from more than half the people.

And at that time, the
scientists in Australia,

Robin Warren and Barry Marshall,

linked that bacteria to ulcers.

And that was a very important discovery.

Changed our whole
approach to ulcer disease.

And they won the Nobel Prize.

It identified Helicobacter
as a bad guy, as a pathogen.

Since then, doctors have been trying

to eliminate it from everybody.

But there's more and more evidence

that Helicobacter has benefits as well.

It benefits our immunity.

And it may be that the
loss of Helicobacter

is one of the factors that's
driving childhood asthma.

We and others have data that support that.

There's evidence that Helicobacter
is bad for your stomach

but it's good for your esophagus.

And with Helicobacter disappearing,

we have diseases of the esophagus

that are increasing
dramatically, like reflux,

and something called Barrett's esophagus,

a form of cancer that was very rare

which is the fastest increasing
cancer in the United States,

of the esophagus.

There are new forms of stomach cancer

that didn't seem to exist before.

These organisms that are
highly interactive with us,

the same organism may have

both good features and bad features.

- So when Helicobacter
goes out of control,

the next thing you know
you're on antibiotics,

proton pump inhibitors, all the stuff

that people end up getting
on because of ulcers.

Is there another type of species

that might have been there synergistically

that has allowed this
to go out of balance,

or is it the specific one?

- The question is, a lot of
people have Helicobacter.

Only a few people get ulcers,

and a few people get stomach cancer.

So why is it those people
and not the others?

That's an active area of research.

We don't know the answers.

- The majority of microbiome
studies, I would say maybe 99%,

when you look at them see, you can say,

okay, this person has cancer,

this person doesn't have cancer.

You see a dysbiosis in one person,

and you don't see it
in the healthy person.

And I think the reality
is that the dysbiosis

is an indicator of the disease condition.

It's very hard for us to say that

the pathogen or this bacteria
cause cancer in an individual.

We really have, I would say
almost no examples of that.

But we see correlation.

So we see a breakdown in the microbiome,

less diversity of species,
some species completely absent,

some pathogenic species become dominant,

which is dysbiotic in nature

compared to a healthy group of people.

But in terms of seeing cause and effect,

other than looking at C diff patients

and seeing that the
pathogen causes a disorder

we have very limited examples.

I think the organisms are
taking advantage of low oxygen,

or a particular nutrient
that's present in the tumor,

and starting to grow there.

This is true that they
are seeing organisms

in unhealthy tissue throughout the body,

and I think it's a matter

of taking advantage of that environment.

But the flip side of this

is that we're now in a position where

we can take advantage of those organisms.

So if we know fusobacterium
likes to grow in a tumor,

why don't we create species

that are able to consume tumor cells?

And I think that this
is definitely an area

of the microbiome that
warrants further research,

taking advantage of organisms
that we think are bad for us

and seeing how we can utilize them

in areas where they grow,
for example, in tumor tissue,

or create a disease in the
gut or the lining of the gut.

- It almost comes back to kind
of the metaphor of gardening

and healthy soil.

If your soil is unhealthy,

bad things grow there type of thing.

Can you speak to that metaphor

for just kind of the
human health condition

in the gut and all that?

Like, what a healthy
environment would look like.

- In terms of a healthy environment,

and I'm sure this surprises
you, but I'm an avid gardener.

And I have seen some
years that the garden's

just been fabulous and gorgeous

and some years it's struggled.

And usually the years
where it's done really well

are the years where I've gotten
rid of grubs in the soil,

and I've added fertilizer,
and taken all the weeds out,

and given it what it needs to be healthy.

And I think the same thing
happens with the human body.

I do believe that if you
give the human microbiome

what it needs to be
maintained in a healthy state,

either feeding the bacteria

or not putting too much
stress on your body,

getting the right diet,
and getting enough sleep,

that we definitely see the
positive benefits of that.

- We drop pesticides on our plants,

we sterilize our shrink wrap food,

and we bomb cancer.

Perhaps we're seeing a
recurrent theme here.

A worldview or operating system

that's been holding us in
an us versus them approach.

Them, who's the enemy anyhow, nature?

We see a war against nature
itself on a planetary scale

and on an interpersonal one,

waging war against the microbes

that connect us with all life.

This shift away from
military style medicine

into a more holistic and
nature-friendly model

is rocking the foundations of healthcare.

We've seen the light, but it's taking time

to shake off old habits
and belief systems.

Here's some key points from
this last powerful segment.

As cancer is rising, microbial
diversity is decreasing.

Is there a connection?

There are different types of bacteria

found around cancerous
cells versus healthy ones.

Can this inform diagnosis and treatment?

If so, this means we may be able to detect

a pro-cancerous environment
years before cancer arrives

by understanding what
bacteria belong where.

And we know that there's a web of life

that seems to communicate
information from cell to cell

and that the microbes are a
key link in this signaling.

They're the missing puzzle piece.

We also know that genetic predisposition

is only part of the equation.

Lifestyle and terrain
are critical components

that can't be overlooked.

Amazing, isn't it?

The microbiome appears to hold the key

to winning the battle against cancer.

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win the war against cancer

and fight these chronic diseases.

Now we pivot back to the gut, why?

Because our experts have
consistently taught us

that this is where 70% of
our immune system resides.

And with all of the food
and environmental challenges

confronting our microbiome

this is an important system to nurture.

The immune system is
where inflammation starts

and where autoimmune
reactions tend to happen.

So when we look at cancer, diabetes,

or any other condition,

we need to go back to
the root of the problem

and start making corrections there.

- We're most excited
about the basic biology,

about basically discovering
how the microbiome

or microbes in our gut or environment

work with our immune system
and our nervous system.

So essentially, trying
to understand what is

the fundamental aspects
of just our own biology.

- I realized how the intestinal tract

was the biggest immune organ of the body.

The intestinal tract
could create inflammation

if we weren't eating the right things,

if we were eating foods
that we were sensitive to,

and that that inflammation
could be the underlying cause

of so much of the chronic complex
illness that we see today.

- Remember, one of the key
functions of the microbiome

is to maintain the gut lining integrity

and that part of your immune system.

So, helping that to heal after an insult

can be really important.

And then eating lots of whole,
generally plant-based foods.

Those fibers and those whole
foods feed the good bugs

and the good bugs grow.

- So I learned about the importance

of microbiome and immunity

because of the importance
of the relationship

between inflammation in the
gut and the immune system.

And then around the year 2000,

that's when the medical
literature started talking about

the bacteria, and it's
the bacteria that matter.

And in fact, that was in 2000,

now we actually have something

called the Human Microbiome Project,

which is very similar to
the Human Genome Project,

where the National Institutes of Health

has actually committed
to really understanding

in a very, very detailed way

what is the composition of the microbiome.

- The immune system is a
set of specialized cells

that are either roving around the body,

or they're what's called sessile,

meaning they're hanging
out in certain places.

For example, we have mast cells

in every surface of our body.

And those mast cells are
basically hanging out,

sampling everything that's going by.

They're sampling pollens, or infections,

or things like that,

and they're "making a decision"

about whether there's something
worth reacting to there.

The name of the game with immune cells

is they are programmed to react

to things in the environment.

- What is happening in this lab
that makes you most excited?

Like what are some of these findings

that are really intriguing?

- It's traditional wisdom that

the immune system responds to bacteria,

but customarily we think
of infectious agents

and how the immune system attacks

microbes that may be invading us.

But what we've learned
over the past decade

is our immune system
is actually augmented,

or primed, by the microbiome.

In other words, the microbiome

improves the function
of our immune system.

It augments certain activities

that are not found in the
absence of a microbiome.

- The whole immune system was
setup in a very primitive way

to be able to reject foreign invaders

or to repair against some
kind of trauma or damage.

And these cells are
made in the bone marrow,

and they're made in the thymus

when we're very, very young.

And then there's also a little
bit going on in the spleen.

So they're made in these organs

and then they're released
into the environment.

And as I said, they
either take up residence

in places like the skin,

or the lining of the nose,
or the lining of the gut,

or they're constantly in circulation.

Many people think that the immune system

is mostly in circulation.

But it's also lining the gut.

It's also lining the nose.

It's lining the eyes,
it's lining the mouth.

- Guess why we have an immune system.

It's basically because
of the microbial world.

And the normal function
of our immune system

in this cohabited body of ours

is just proper management
of relationships.

Think of the mediator in a dispute

between partners in a
business relationship.

Or think about

the folks that broker discussions between

large organizations.

That's your immune system.

And so, it's absolutely essential

for the normal relationships
that we have with our microbes.

- And so again, it's a
conceptual shift in thinking that

the immune system actually
requires certain bacteria,

non-infectious bacteria,
for its optimal activity.

And if the immune system
doesn't function properly

then that actually
results in human diseases.

So again, beyond infectious disease,

an overactive immune
system results in allergy,

results in autoimmunities

such as multiple sclerosis, and lupus,

and rheumatoid arthritis.

And again, all of these disorders

being linked back to the microbiome,

largely in animals, but
in some human studies,

suggests that modulation

of the immune system by the microbiome

may be a potential therapeutic option

for allergy and autoimmunity.

- Can you speak to the experience

of the patient in this case?

It might start with fatigue,

it might start with brain fog.

Like, this could be going on for a minute

before they start becoming
properly symptomatic.

They just don't feel well.

- So there's so much
interconnection between

the microbial world,
for example in our gut,

and the biology going on in the gut wall,

and then the rest of us.

And this semipermeable
selective transport barrier,

which is normally bringing
signaling molecules,

and metabolites, and immune
regulators across, deliberately,

can easily become overwhelmed,
or faulty, or broken.

And now, some of those
same immune regulators

that were doing normal monitoring
and maintenance functions

are causing an immune response

that is subtle and yet insidious,

and almost profoundly basic

to how we feel and how we operate.

And it's exactly those same kinds

of immune signaling
molecules that cause fatigue,

that cause poor nutritional status.

So there's literally a physical
basis for this fatigue.

These same molecules cause fever.

They cause and regulate immune
function throughout the body

in places where immune function is itself

linked to local cell
function, in the liver,

local cell function in the brain,

local cell function, you name it.

And that's why these
breakdowns in barriers

are so fundamentally important

to everything about who we are

and what regulates our
normal health status.

- We have a handful of
examples of organisms

that can modulate the immune
system in a beneficial way.

In some cases the actual molecules

of those organisms are known,

and they're secreted factors that sense,

are sensed by our own immune cells

and then augment the function
of those immune cells.

But unfortunately, in a
vast majority of cases

where the microbiome has been linked

to an autoimmune condition

we don't know the specific organisms

which are mediating those health benefits

and therefore we don't
know their molecules.

But this is ongoing work.

Many laboratories are
interested in identifying

particular organisms and molecules

as a mechanism to develop new therapies.

- What's happening on the skin is,

nine times out of 10, happening inside.

There are some genetic conditions

that can lead to leaky epidermal barrier,

that if you want to talk
about we can talk about,

and need to be addressed locally.

But by and large, it's an inside-out job.

So acne is an inside-out job.

You can do secondarily
topicals and applications

but yeah, acne, in my
experience, teen acne,

requires a dietary change,

it requires significant drop in the sugar,

it requires pulling out
the top antigenic foods.

Very commonly it's dairy,

which is really hard
for a teen to give up.

But acne is tough to live with.

And in my experience
treating many kids with acne,

they're really, by the time
they come into my practice,

they're willing to go the distance

and hang in there with the diet.

Some "gut work" is going to be needed.

We're gonna measure what's going on,

look at what's going on in the microbiome.

We'll look at nutrients,
and correct those.

And along with a good, healthy, clean,

low processed, low
antigenic, high veggie diet

you can turn around acne.

It's very doable.

- We have incredible patient stories.

And in our approach to medicine
we often, if not always,

I hate to say always for
everything, for anything.

But we almost always start with the gut.

- So there's an interesting
thing about eczema.

Most parents will come with their kids

and they have this presentation
of eczema somewhere,

face, knuckles, whatever,
could be anywhere.

And most oftentimes are
seeing a dermatologist.

The dermatologist says,

well you need some sort of antibiotic.

You need some sort of cream.

You need something to
knock out this eczema.

- A great patient example.

I have a 24 year old woman

with Behcet's autoimmune vasculitis.

This is an autoimmune disease

that results in ulcers in the mouth

and all the way down the esophagus.

Young woman.

She also had acne, weight gain, insomnia.

She was just inflamed.

She had been fired by the
top rheumatologist at Cornell

because none of his drugs were working.

- The reality is if you
can intervene early enough

with these kids with
what's called prebiotics

you can reverse the eczema.

So, there's something called
fructooligosaccharides.

Very sweet, it's almost like sugar.

And if can titrate the
levels up on these kids

of fructooligosaccharides
early on in their life.

We're talking one year
of age or younger, two.

And you can get the levels
of these things to increase,

you'll see the eczema go down.

So that's telling me, as we
see in the research studies,

that the eczema isn't
necessarily a skin presentation.

The eczema is a gut presentation.

And most often it's missing microbes.

It's missing gut bugs.

- And so she came to us at my practice.

And honestly, I was nervous.

This is a high table
stakes type of patient.

I really want to help her,

and I'm hoping that
this approach will help.

But we know that the
immune system is regulated

through the gut, through the microbiome.

That leaky gut can play into it.

But oftentimes people have
developed food sensitivities

that they didn't necessarily
have day one of life

but they might have developed later on.

And so we took what's known
as our gut healing approach

with this patient.

We eliminated a number of trigger foods

that are common in autoimmunity,

like gluten, like dairy,
like sugar, a few others.

- You see trials where if
parents will hand wash dishes

versus putting them in the
dishwasher, kids get less eczema.

- We embarked on, over six
weeks, a gut healing protocol

including a couple of
supplements, some probiotics,

some supplements that help
heal that lining of the gut

that's gotten disrupted,

some supplements that help kill
off some of the bad bacteria

because on her stool test she
had a preponderance of yeast

because she'd had a lot of medications

and antibiotics over the
years, especially for the acne.

She'd seen me twice and them I'm like,

okay, we've got to keep going.

This takes a long time.

I'll see you in a month or so.

And she comes back in,
and I'm nervous honestly

because I'm like, what
if she's not better?

I'm like this.

And she comes back and
ulcers are completely gone,

disease is basically in remission,

her skin is cleared up, she's
sleeping, she's losing weight.

Her mother is crying in my office

because we've given her
young daughter he life back.

I still get emotional when
I talk about this case.

And her mother has been
a patient of ours now

for a while as well.

And it's incredible, right.

But we just looked
holistically at the patient,

and we understood that

the immune system is being
triggered by something

and the immunosuppressive
drugs aren't enough.

If you don't address the
underlying cause of a problem

it will always outpace the
drug's ability to suppress it.

- You'll see trials where

if the parents will drop a pacifier

on the ground and pick it up,

and instead of rinsing
it off under the water,

they'll lick it and
give it back to the kid,

you'll get lower eczema.

And dogs, and if they're
growing up on farms.

Meaning, if they get more exposure

to lots of different bugs

the kids don't get eczema.

- The next case, Johnny,

he came in with rheumatoid arthritis.

And they were wanting to put him on

a strong immunosuppressive
drug to help with his RA,

which causes joint pain
and joint destruction.

And he said, I don't have
any digestive symptoms,

but I'm wondering if
there's something in the gut

causing these symptoms.

And so, we found small intestinal

bacterial overgrowth with Johnny.

And we used a course of
herbal antimicrobials,

and he responded fantastically.

He was using medication
previously on and off.

He was using some steroids
and anti-inflammatories,

was able to come off all
medications and felt fantastic.

- I can talk a little bit
about rheumatoid arthritis

because I have a number of
patients that I treat with that.

And I do think the microbiome

is a very important part of that.

We know, for example, that
there's certain bacteria

or combinations of bacteria

that can trigger rheumatoid arthritis.

Very good work done on that.

- And there has been other data published

showing an elemental diet,

which is essentially a
gut-friendly meal replacement

can be as effective as the drug prednisone

in quelling inflammation and treating RA.

An elemental diet is
essentially a meal replacement

that's hypoallergenic,
pre-digested, and gut-friendly.

It's oftentimes used in people

with inflammatory bowel disease.

Because of all the ingredients
being pre-digested,

your intestines don't have to work at all

to absorb everything.

And if you have something
like a bacterial overgrowth,

since the solution is absorbed

in the first couple feet
of the small intestine,

nothing makes its way down the line

and it can't feed any of
the bacteria down the line.

- I've been doing microbiome testing

since it first became available.

I started doing the earlier stool testing

where you look for certain organisms.

Did you see if they would grow,

look at them under a microscope.

But then when the DNA testing came out,

we called this sequencing based testing.

I was an early adopter.

So I've been doing this

for many, many years in our practice.

At first there was a lot
of excitement about it.

We though, okay, we're
gonna find the one bug

that caused rheumatoid arthritis,

or the one bug that caused
autoimmune thyroiditis.

And we had pretty good literature

that appeared to show those associations.

The problem is that
when I actually started

doing the testing I
didn't find those bugs.

What I tended to find

was that there was a low
diversity and richness.

Now, these are technical terms

that the biologists use,
the microbiologists use,

to describe the health of
the overall microbiome.

And this is, I think,

something that most everybody agrees upon.

There is a lot of interest
in microbiome and asthma.

Again, asthma has just
shot up after World War II,

consistent with this period

when our microbiome seems
to have changed the most,

the era of antibiotics.

And it may be that the
lost of Helicobacter

is one of the factors that's
driving childhood asthma.

We and others have data
that supports that.

And so, we're interested in
Helicobacter as a protector.

We're also interested in certain organisms

in the intestine as protectors.

There have been some studies of children

showing certain organisms are associated

with protection from later risk of asthma.

This is a rapidly emerging field.

This may be one of the
fields where there will be

breakthroughs more
rapidly than other fields.

- The immune system has
different ways of responding.

Some of it is very specific
and some of it is general.

And I think what it takes for
the immune system to decide,

now we've got a problem,

versus this is kind of
normal noise and background,

we need to be aware but not go crazy.

- So when you see someone
with compromised immunity

and recurring upper respiratory infections

is there a common pattern that you see

in mouth dysbiosis or something?

- The connections between mouth,

and lungs, and intestine, are complicated.

They do include the immune system,

which regulates and acts locally

but also has systemic effects.

So what happens in the
gut does affect the lung

through the immune system,
and vice versa, potentially.

But then there are the
organisms that themselves

that make their way from the
gut back up into the mouth

and down into the lungs.

And there is a connection there.

It's complicated because
it involves stomach acid,

it involves abnormalities
of esophageal function,

but it clear that asthma is more common

in people who have reflux, esophagitis,

and reflux of material
from the upper intestines

up into the mouth and oral pharynx.

And those are definitely
places of leverage

where we can potentially
modify the likelihood

of something like asthma.

- So we know,

especially from studies on
the microbiome in the gut,

that environmental toxics
have a dramatic impact

on the bacteria and fungus in the gut.

It really disrupts things.

So what I've found is that a lot of people

will really have a flareup
of this chronic sinusitis

if they're either living in toxic mold

or they're exposed to chemicals.

So a lot of times if we can do the work

to help to detoxify the body

and to make sure that
they're not being exposed

somewhere in their environment,

whether it's their home, their car,

their work, their school.

Then the immune system works better

to keep the microbiome
in the sinuses intact.

- I had sinus infections
all the time as a kid,

so I just took antibiotics
every month, for years,

because that's what doctors said to do,

every time disabling my gut.

I wish I hadn't have done that.

- I do the least invasive things first.

We build the gut microbiome.

We make sure the sinuses are treated.

We make sure that the
body has all the nutrients

that it needs to do the rebuilding.

And then if they're
still not getting better

than they probably need an antifungal

that crosses the brain,

because obviously we
can't do a brain biopsy.

I have been really
leery about using silver

because to me it's a metal

and I see a lot of people
with heavy metal toxicity.

It's like, I don't really
feel comfortable doing that.

But as far as the sinus
it's really, really helpful

because it has some antibacterial

and then some antifungal coverage.

- I went from sinus infections every month

for about 15 years of my life

to almost never getting one.

And if that starts to happen,

instead of taking antibiotics

I use this antibiotic that
we used before we had them.

It's called iodine.

And what I do is based on an
old Ayurvedic yoga technique.

But you put your face in a
bowl of iodized saltwater

and you wash your sinuses.

Who would have thought.

Stuff like that that's
been known traditionally

for a long time works
really, really effectively.

And if I had to use an antibiotic

it would be in a nasal spray.

Why would I kill my gut bacteria,

so I can hopefully get to my sinuses?

It doesn't even make sense

but that's what we've always done

so that's what we keep doing.

- One of the interesting
stories that I have

from one of my personal patients is that

a cockroach can actually
be very allergenic.

In talking to this person
with chronic sinus problems

discovered through the conversation

that there had been
issues with cockroaches

in the apartment that they had.

And so, you can see how these triggers

can just incite an immune
reaction in your body.

I may be exposed to cockroach
and not have a problem.

You may be exposed to cockroach
and may have a problem.

The reason for that could be because

of the resiliency of our immune system.

- If you have something
like a really bad headache

and it's only happening once a year,

by all means take an ibuprofen.

If you're chronically having headaches,

and you're chronically
taking these medications

that also then have side effects

and are causing abdominal pain,

and bleeding, and other issues,

you're pretty motivated
to try something else.

And so, I think people are
beginning to understand

that true health and
wellbeing in the long game

and are looking for solutions
that get them there.

- The headaches for me were pretty big.

It would come on all the time

and it would really, really drive me nuts.

And so, a friend of
mine at that time said,

why don't you go see
a naturopathic doctor.

And I remember going,
a what, a natural what?

I've never heard of such a thing.

- Well, in my experience,

diet is always a piece
of migraine headaches.

Without question, it's
always a piece of it.

Even if they cycle with hormones.

So even if you're sure
that this is related

to sex hormone imbalances,

diet is just always a piece.

And that means that the
microbiome is a piece of it,

and the gut integrity is a piece.

Sometimes there are
nutrient insufficiencies.

Magnesium is commonly needed.

Sometimes allergies play a piece.

Inflammatory reactions to
foods always, in my experience,

play a piece in migraine
headache patients.

- And so I went to see
this lady in Vancouver

and it really changed my life

because in the first 90
minutes, first of all,

I'd never spent so long
with a doctor in my life.

Usually I had a prescription
as soon as I sat down.

And so, it was just fascinating

that she asked such deep questions.

I mean, they're not very
deep, it was just detailed,

it was really thorough.

And I can't believe it.

She figured out what was
causing a lot of my headaches.

- I generally use a combination
of an elimination diet,

pulling out the top antigenic foods

like wheat, egg, dairy, so forth, soy.

And then I'll do some laboratory testing

to see if there are any outlier reactions.

And then we embark on a
therapeutic diet program

for a set period of agreed upon time.

So my patients are really clear

of what they're getting into.

And they work with a nutritionist

to make sure it's nutritionally replete.

And then we will challenge
those foods one at a time

to see what the culprit foods are.

This particular migraine patient
that you're asking me about

came to me in our first office visit

before I had any laboratory data on her,

told me that without question
she would not give up eggs.

And I said, okay, but
let's just at least look.

Can we just test?

And then she comes back to the office,

and we review everything
in the second visit,

and then I'll prescribe the plan.

And sure enough, I mean, I
knew this would be the case.

I've seen egg as a culprit
in migraine headaches

a handful of times.

But wildly allergic to eggs.

And so the data actually
helped compel her, all right,

to reluctantly agree to give up her eggs.

I mean, it's kind of a funny story

because she just totally dug
her heels in around eggs.

And I didn't even say anything.

So anyway, during that therapeutic trial

her headaches, her migraine
headaches, stopped.

- So, I ask this of everyone.

If you, god forbid, were to develop

some sort of chronic disease,
an autoimmune disease,

what would you do for yourself?

- I would go see myself at my practice

or go see one of our
other amazing physicians

who work with us.

I would do a gut healing protocol.

I would eliminate trigger foods.

I would work with supplements
that help heal the gut

and lower inflammation in the body.

- The gut microbiome
produces lipopolysaccharides

and things that impact our immune system

and modulate our immune function,

and it also creates neuropeptides
that modulate our mood.

So every aspect of a
human body chemistry book

takes place in the gut microbiome.

- I would do in-depth testing of genomics,

and the microbiome, and
hormones, and toxins,

and take a really broad look.

I would sit back with myself
and say what triggered this.

What I under an amazing amount
of stress at some point?

We know that stress, and
this is well established,

stress is the number one
trigger for autoimmune flares.

- We did a study in 2014

where we took 400 healthy blood donors

and we checked their blood to see

what type of antibodies they produced.

And that people had lost
their immune tolerance

and started to react
against food proteins.

And the food proteins we were checking

were milk and wheat proteins.

We found that 50% of them

had antibodies to their brain tissue

meaning that their immune system

was causing an inflammatory
reaction in their brain.

- Old time doctors who were practicing

a naturopathic medicine

would ask somebody to
list your favorite foods

and be like, okay, those
are what you're stopping.

I mean, that's like the old time trick

to identify what people are reactive to.

- The problem is, many
people when they start

to react to foods start
restricting all their foods.

And when they start
restricting all their foods

they lose their good diversity.

So, we're actually
having a complete change

in how we treat patients
with chronic inflammation

and food sensitivities by
looking at the microbiome

and encouraging them to eat
a really high plant-based

type vegetable protein source

so they can really get that function back.

- So we know now that what
we're eating repeatedly

we're more vulnerable to
mounting a immune response to

if we've got a damaged microbiome

and any degree of intestinal permeability

because it's those proteins
that are going to be exposed

to the immune system over
and over and over again.

- I think there's maybe two
extremes that come into this.

There was a woman who was
just starting on her journey,

and she can benefit just by getting off of

soda, and sugar, and processed foods.

For her it's kind of easy.

Go on an unprocessed food
diet, a whole foods diet,

and you'll likely see a lot of benefit.

But then there's the person

who has been at this for a little while.

They've been reading,
they've been researching.

And now they come in.

I can't have gluten, I can't have grains.

I've also heard that I have
an autoimmune condition

so I can't have any of the foods

not allowed by the autoimmune paleo diet,

which are nightshades, and eggs,

and nuts, and seeds, and beans.

So, very quickly people end up

cutting all these foods out of their diet

without a plan for how to figure out

what should they not be on
and what should they be on.

And oftentimes when they get to my office

they're off of a number of foods.

Sometimes they're
underweight or really tired

because they're not eating enough.

And as soon as a person in a
position of authority says,

you know what, you can
bring these foods back in

and you'll probably be okay
but let's see how you do.

And then they start introducing
and eating more foods.

They come back in three weeks later.

Ah, I feel so much better.

I had some gluten, I had
a little bit of dairy.

The dairy bloated me a little
bit but it wasn't too bad,

and the gluten was actually okay.

- So the key concept
is once your microbiome

loses its diversity you lose tolerance.

And as your microbiome goes
more diverse you gain tolerance

and then you're not as
reactive to yourself

or to the food proteins
or chemicals around you.

- Really two aspects here that are key.

There's the microbiome,

which is the world of bacteria

and other life that live in your gut.

And then how those bacteria and other life

interface with the immune system.

And that's one of the pieces

that is sometimes left out of the equation

which is the immune system
is very important also

because foods reactions
are in part, in large part,

mediated by your immune system.

So it's not just the bacteria.

It's also the immune system.

- Our microbiome is
interconnected to our entire body,

and our gut is constantly
communicating with our brain,

our lungs, our hormones.

And this inner community has so much to do

with our overall health and wellbeing.

We can use this knowledge
to help heal ourselves

and our loved ones.

It's important to work with your doctor

as you work through eating, drinking,

and living more probiotically.

Our journey through the
microbiome connection

has the hope we need

to have more control over
our health than ever before,

as we see all these interconnections

with our body's systems.

Here's a quick review
of what we've learned.

70% of our immune system
is around our gut lining.

Skin disorders, allergies, migraines,

sinusitis, and hormonal problems

all trace back to the gut
and an unhealthy microbiome.

Often it's not specific strains

but a lack of diversity
causing these problems.

This diversity comes from a diet

rich in colorful fruits and vegetables.

We also see that missing
fructooligosaccharides

may be the culprit for
people with skin problems.

It's hard to believe that
the microbes in our gut

can affect so many
illnesses we suffer from.

But what about the number
one condition in America?

What about heart disease?

It's killing millions every year,

and what we've learned
about the microbiome

may be the missing link to a solution.

Perhaps we've been chasing
the wrong culprits.

Here's what some great minds

in science and medicine told me.

- We know there's a connection

between the microbiome
and cardiovascular disease

because when you take out plaque

you often find bacteria in there.

Now there was a misconception for years

that the body was basically sterile,

that you only had bacteria in your nose,

in your mouth, in your gut,

but you didn't have
bacteria anywhere else.

We used to think the womb was sterile.

But now we know there are
bacteria all over the place.

And most of them are hiding,

they're not causing any problems,

and the immune system is tolerant.

So, what about the bacteria
they find in the plaque?

What's that bacteria doing there?

Is it just hanging out?

Did it find a nice apartment
to live for a while,

or is it actually part of the process?

Some people believe that those bacteria

are part of the process.

What's some of the data
that leads us to think that?

We know there's a strong connection

between gum disease and heart disease.

And what is that?

We know that if you've got
certain bacteria in your mouth,

overgrowth of certain bacteria,

it creates systemic
inflammation in the body.

So it could just be that the
local inflammation in the mouth

from those unhealthy bacteria
causes systemic inflammation.

Or maybe the local
inflammation in the gums

is creating leaky gum syndrome.

Not leaky gut syndrome
but leaky gum syndrome,

and those bacteria are
seeping into the bloodstream

and they're ending up
in any irritated areas

that lie on the arteries and saying,

hey, I'm gonna take up residence.

This looks like a good spot.

And then the immune system says,

wait a minute, you shouldn't be there,

so there's a reaction to them,

and that reaction causes
inflammation, and swelling,

and eventually plaque formation.

- Heart disease is not just because

cholesterol is blocking your arteries.

We now know that it's so
much deeper than that.

There's different particles
that they're talking about.

Small particles, large particles.

But even beneath that is inflammation,

the immune system that's imbalanced.

It's in kind of like a startle state

where the whole person is in an imbalance

in the autonomic nervous system,

or the hypothalamus-pituitary-adrenal
access,

which is a simplistic
way of understanding,

it's basically how the body
gets back into balance.

That's out of balance.

And those are the systems
that bring us back

to a balanced, healing state.

- I'm the fourth doctor in my family.

And when I decided to go into
medicine I met Dean Ornish,

who came to Omaha, Nebraska

when I was a senior in high school

and showed that if you had a heart disease

and were scheduled for a heart bypass

that you could use lifestyle medicine

and not need the bypass.

Now, 35 years later,
we found he was right.

And a big factor of the inflammation

in the heart that causes heart disease

is the inflammation in the gut.

I think of it as fire in
the gut, fire in the heart,

and also now fire in the brain

because what happens in
the microbiome of the gut

can drive the microbiome inflammation

throughout the rest of the body.

- The biggest things I see are patients

who are on cholesterol-lowering
medication.

And if you actually look at the research

looking at a 10 year, 20
year, 30 year, 40 year,

your decrease in having a
stroke or a heart attack

being on a statin,

you'd actually be amazed
at how many cardiologists

or doctors don't know the stats.

And if you look at the stats,

it's amazing how misconstrued it is

even in the guidelines of cardiology,

and how it's actually
you're decreasing the risk

maybe by 2.7%.

But if you were to look at,

well why is that patient's
cholesterol high?

Is it that it's recirculating

and being reabsorbed in
the gut and not going out?

Or is it that the liver
is making too much,

which a statin medication addresses.

So it's amazing.

It's just education I
don't think many of us

are actually taught what the
root cause of the issue is.

And so, of course if I thought

the cholesterol was the issue,

which 50% of heart attacks and strokes

happen with perfectly
normal cholesterol levels,

then of course my role
would be to lower it,

or to get rid of it.

But now we're finding, okay,
it's the bystander possibly

and maybe there's
endothelial issues going on

that's dysfunctional, and that's
coming there for a reason.

That's really not the issue.

So, statins being the sort
of billion dollar industry

and one of the number one drugs used

that makes a lot of money,

is it really saving lives,

is it really doing more harm than good?

I don't know.

It's a good question to ask.

- One of my most disheartening cases

while I was a medical student

was a woman that came
in with abdominal pain.

And she had had abdominal
pain for three days,

and they decided it was her gallbladder.

She was scheduled for surgery.

I asked for an EKG, which
is a tracing of the heart.

It showed she'd been having
a heart attack for three days

and no one ever considered
it could have been her heart.

She ended up having emergency surgery.

She was told after the surgery

that half of her heart was damaged

and that she would be a cardiac cripple

the rest of her life.

That was not good enough for me,

so I sought out one of the world's experts

in metabolic cardiology

that knows if you add Coenzyme Q10,

carnitine, D Ribose, magnesium,

some of these mitochondrial supporters.

The mitochondria are the
factories of your cells,

how they take food and make energy.

And you can spray a little WD-40 in them

and make them spin faster.

So I decided that time to
never let this happen again.

- I would say the number
one thing I see on the rise

is patients with heart disease.

Younger patients dying earlier.

I mean, the things I saw,
for example fatty liver.

I always thought it's
something that happens

in older men, alcoholics.

I just had a 35 year old
female with fatty liver.

And that's a big deal.

That means your liver can no longer

do its job like it used to,

and the liver is so
important for longevity,

for how long you live.

To go back to how this
affects your health,

the microbiome, the
microbes that live with you,

I think the biggest thing I
see is not just gut health.

I think most people think the microbiome

has to do with indigestion, bloating,

gas, diarrhea, constipation.

But, to be honest, from me
it's actually more about

the bigger organs that
really affect your longevity,

which is your liver,
your heart, your brain.

- Can we talk about this kind
of full body systems approach

to medicine that's now
starting to come up,

and what that means for all of us

to just change our diet downstream.

- If you look at a lot
of chronic diseases,

like heart disease, and hypertension,

and diabetes, and obesity,

non-alcoholic fatty liver disease.

All of these diseases have
a component of inflammation.

Many of these diseases have
probably been made worse

by poor dietary choices.

I'm not suggesting that there's
an immediate correlation,

but diet matters.

There is this idea of food as medicine.

And what we eat, and the
nutrients that we take up,

feed all of the cells in our body

just as they feed all of the
bacteria in our microbiomes.

- There's this food industrial complex

that's also tied into the medical complex.

It's a trillion dollar
industry in and of itself.

That's just on chronic disease.

So can you talk about the relationship

between this junk food behemoth

and the chronic disease business

that keeps kind of passing the
patient between each other?

- I've got a friend who went
in for heart surgery recently.

He was wheeled into the operating room,

and he was looking at his
wife and kids, looking at him.

And that was the hardest
moment of all for him

because he saw his kids looking at him

not knowing if they would
ever see their dad again.

And he came out of the heart
surgery, thank goodness.

He survived it.

And then they served him a cheeseburger

for his first meal in the hospital.

The doctor said not a word

about the connection
between food and health.

- We do an abysmal job in
heart disease prevention

in our medical system right now.

We're looking at four very basic markers.

The current studies show
that the statin drugs

really don't work well for women,

particularly after menopause,

and that there's possibly
a 50% risk of diabetes

in women using those medications.

- At first he said, I don't
want to make any change

because I don't know how
long I've got to live,

and I don't want to give up

the one biggest pleasure I've got left.

My body doesn't work all that well.

It's painful to me, it's
painful to be alive,

and I don't want to give up

the pleasure of the
foods I'm familiar with.

And his wife said, but
sweetheart, I want you in my life,

and I want our kids to have a dad.

And so, we've got to make these changes.

So thank goodness, he did,
and he lost 40 pounds,

and he got off all of his high
blood pressure medications,

and his heart is functioning
beautifully and healthfully,

and he's now hiking and
jogging and running,

and it's gotten easier and easier

to love foods that love him back.

And so my friend is a symbol to me

of what's at stake here.

Because he had the good
fortune to find out the truth

and a wife who helped
him put it into action.

But not all of us have that luck.

And it's why there's 14
million people dying a year

from heart disease every
single year on this planet.

It's the number one most easily

preventable disease there is.

The Tarahumara Indians in
Mexico have no heart disease,

I mean like zero.

If you were a heart surgeon
there you would be unemployed.

You'd make more money selling pencils.

- So what we like to do

is we like to look at a
more personalized approach.

Our heart panel has 27 different markers,

and one is a marker called TMAO

which is reflectively directly

of the inflammation in the gut.

Again, fire in the gut, fire in the heart.

We also know that women

are more predisposed
to autoimmune disease,

12 times more likely than men
to get autoimmune disease.

And if a woman has autoimmune disease

she's 10 times more likely
to have a heart attack.

So the inflammation fire
of an autoimmune illness

can drive the fire of a
heart attack and/or stroke,

and most likely dementia
or Alzheimer's as well.

- The reality is that we
can learn from these people.

We can recognize that
the heart disease rates

we think are normal in
the modern United States

and the modern world
are completely optional.

It might be typical, but it's optional.

And I want us to get that truth out there

and to recognize that we've got hospitals

that literally have McDonald's in them.

We've got doctors who are
telling their patients

what they eat doesn't matter.

My own aunt went in

for bladder cancer surgery this last year.

We didn't know if she'd live.

Not once did any of her oncologists

ever mention the connection
between food and health.

And we know for a fact
that 90% of cancer cases

are caused not by
genetics, not by bad luck,

but by lifestyle, environment, and food.

- The cure is really prevention.

First you need to get
the data to identify it.

I call it my trifecta,

and this is what I
learned from Dr. Ornish.

One is, you've got to
do the right blood test.

I'm shocked how many
people come and see me

and have never heard of
these advanced markers.

You can look at your
cholesterol and break it out,

called a fractionated cholesterol.

There's also specific inflammation markers

that are geared to the lining of the heart

to tell you number one, who has a plaque,

and number two, who has one
that's most likely to rupture.

We can now predict the ability

of someone to have a heart attack

six months before they
actually have the event.

So by looking at the right blood testing.

For men, we like to do a calcium score,

which looks at calcium
deposition in the heart.

For women we like to do

a carotid intima-media thickness test,

which is a specialized ultrasound.

Again, we don't like to
use radiation for women,

particularly in the chest,

so it's an ultrasound test for women

in the carotid artery of their neck.

It's a calcium score for
the arteries of the heart.

The third thing is looking
at the actual endothelium,

or the lining of the heart.

We were taught in medical school

that the largest organ
in the body is the skin.

Most doctors still think that.

They're wrong.

It's this endothelial lining.

It's this lining of the blood vessels

that has its own immune system

and most likely its own microbiome

that talks to the microbiome of the gut.

If you've got leaky gut,
you've got leaky heart.

Those type of inflammations
that we see in the gut,

we see in the heart vessels,
and you can identify them.

- The microbiome scaffolding of the body,

it's not just the
scaffolding, it educates,

it maintains the immune system.

Believe it or not, if you
have an immune disorder,

any inflammatory disorder,
an autoimmune disorder,

the root is a problem in the microbiome.

It's lost its power.

The scaffolding is weak.

So, what's amazing about heart disease,

it's not just cholesterol.

That's small, a small component.

It's the inflammation that precedes it,

whether it's different
lipids that are oxidized

because of inflammation,

the immune system is
so-called out of whack,

it's imbalanced.

Or how an over-activated immune system

could cause damage to the vessel wall,

or even how an altered microbiome,

well, the primary cause

is that the microbiome is imbalanced,

which leads to an imbalance
in the immune system,

which then leads to
cardiovascular disorders.

Not just that the vessels get damaged,

and their ability to heal is compromised,

but the heart itself is more susceptible

to arrhythmias, irregular
rhythms of the heart.

- I really feel, particularly for women,

that a heart attack and a
stroke should be obsolete.

We should be able to identify

the canaries in the coal mines,

who are the people who are really at risk.

And by empowering patients,

particularly the women that are at risk,

by coming to conferences.

I'm a teacher.

I've taught 20,000 doctors
in the last four years.

By teaching doctors this

they can then teach their patients.

And really, what a
doctor is is an educator.

My job is to have you come see me

and let me provide you with information

to empower you with knowledge

to help you make smart health decisions

based on your belief system.

Then we work as a team to
get you to better every year.

- If you look deep,
deeper into the literature

about what really causes
arrhythmias, irregular rhythms,

well one, of course, is the
blockage of the arteries.

And then we just said,

well a major contributing
factor is inflammation.

Your microbiome is the preceding problem,

that it's lost its power,

or losing its ability
to heal, to some degree.

And it all leads to inflammation,

free radicals, which
are unstable compounds

that an inflamed immune
system will cause to try to

get rid of outside foreign compounds

and foreign bacteria that
don't belong in our ecosystem.

It's now causing damage to our own cells.

- Well, the data is
coming very, very clear,

besides my personal experience
seeing women misdiagnosed.

For a man that has chest pain

it's the classic elephant
standing on the chest.

That's very rare to see with
a woman when she comes in.

She could be anxious,
she could be nauseous,

she could be vomiting,

she could have abdominal
pain like a gallbladder,

she could have back pain.

Women present with heart
disease different than men do.

Women respond to the therapies
different than men do.

And the evaluation tools
we have for heart disease

are not very good for women.

So we're doing a huge disservice

to the women in our society

about how we can take care of them

and prevent this number
one killer of women.

- Arrhythmias are due to
inflammation and free radicals.

Now, let's heal the microbiome.

Now the free radicals and
the inflammatory response

begins to calm down.

And I've seen this time in
and time out, time again,

that when you tree the microbiome

through microbiome medicine,

those irregular rhythms get better.

And who wouldn't want to see

their irregular rhythms get better

without the use of medicines

that could be dangerous in themselves.

That doesn't mean that
everyone will get off of them,

and I'm certainly not
making that recommendation.

But microbiome medicine
will heal at the root.

And I've seen so many patients,

countless number of patients,

with cardiovascular disease
that got significantly better

because we healed the microbiome

through microbiome medicine.

- The beautiful part of what we're doing

in this personalized approach,

the same therapies we do
to support heart health

support brain health, support gut health,

support skin health.

So women will come in and do our

reversing heart disease program

and they'll say, my
knees don't hurt anymore,

I'm sleeping better,

my friends say my skin looks better,

my hairstylist says my
hair is coming in thicker.

So they have all these other benefits

of taking care of the
bioterrain, of the ecosystem,

particularly the microbiome.

- To think, good bacteria
to help your beating heart.

Inflammation, bacteria, and your gut,

to see how it's all connected

to your cardiovascular system is amazing.

It used to be mostly men
suffering from heart disease

but it's also a growing
killer in women now.

We've been looking at
cholesterol and exercise,

stress reduction and statin drugs,

but we're missing a key ingredient.

There's a bacterial component
to the lethal plaque

that's been clogging our arteries.

Here's a summary of our heart tips.

Cardiovascular plaque
has bacteria found in it.

Certain mouth bacteria can create

systemic inflammation in the body

and are found in arterial plaque.

These are foreign bacteria

that don't belong in our ecosystem,

so basically if you've got a leaky gut,

you're gonna have a leaky heart.

We've learned that women
are more predisposed

to autoimmune diseases, which
often come from a leaky gut.

And we've also learned that
when inflammation goes down,

arrhythmias start to heal.

Again, inflammation starts in the gut.

Heart disease is the
leading cause of death

in the United States, killing
over 375,000 Americans a year.

But maybe we don't have to suffer anymore.

Perhaps you and I can protect our families

by unlocking the healing secrets

of this neglected missing
organ called the microbiome.

So I urge you, click the button below

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Thanks for joining me here
in the INTERCONNECTED series.

Our next episode focuses on
how doctors and scientists

are sharing their new
knowledge of the microbiome

to help and serve the human race.

We can't afford to wait 15 years

for this information to hit main street.

People are losing husbands,
daughters, and friends.

And the cost of waiting
to get well is too high.

Let's look at innovative new
testing you can take at home

and revolutionary treatments
that are very promising.

There's much more happening
than your doctor may know of.

If you want to be healthy, and frankly,

survive in the modern world,

you need to take charge of your health.

And that means taking charge
of the vital information

that you need to share with your doctors.

Again, I'm Dr. Pedram Shojai,

and I will see you in the next episode.