Marvin Singh, MD is a practicing gastroenterologist with a focus in personalized lifestyle medicine. I met Marvin in 2017 when I was asked to submit a chapter to Oxford University Press Integrative Gastroenterology, 2nd Ed.
Marvin has been coediting this behemoth with my IFM colleague Gerry Mullin, MD. (Full disclosure: very large props must go to Nikky Contractor, PhD for the heavy lifting on our chapter).
Marvin’s evolution from a very traditional, academic gastroenterologist to integrative gastroenterologist to a cutting-the-edge personalized lifestyle medicine doctor (folded inside his own healing) is a story I think you’ll find interesting, and relatable.
As we move through his story, I ping Dr. Singh on labs, interventions, books, all sorts of content – lots included, be sure not to miss this one. Brilliant guy, and I ‘d love to hear what you think! Be sure to rate, comment and review New Frontiers, wherever you listen to the podcast – I so appreciate you listening!
In functional and integrative medicine, all roads lead to the gut when it comes to optimal health—and no one knows that better than integrative gastroenterologist Marvin Singh. Dr. Singh completed a residency in internal medicine at the University of Michigan, and went on to complete a fellowship in gastroenterology/hepatology at Scripps Clinic.
Today, Dr. Singh is an assistant clinical professor at UCSD and a contributing faculty member at Andrew Weil Center for Integrative Health, where he completed a fellowship in integrative medicine.
In this episode of New Frontiers, Dr. Fitzgerald talks with Dr. Singh about his path to functional and integrative medicine, the importance of staying current in allopathic approaches, and the best strategies for testing and treating dysbiosis and leaky gut.
In this New Frontiers in Functional Medicine Podcast, you’ll hear:
- How Dr. Singh came to embrace integrative medicine after training in conventional gastroenterology
- Why both allopathic and functional doctors are important for maintaining optimal health
- Outsized power of gut flora in influencing cravings, mood, and other cognitive processes
- How/why eating is a whole-body experience, not just a microbial experience
- Physiological underpinnings of cravings for comfort food
- Underappreciated role that stress plays in disease processes
- Why even functional medicine mandates must be personalized for individual patients
- Dr. Singh’s preferred labs and functional tests
- Importance of staying up to date on allopathic interventions
- Value of testing microbial-related metabolites in the blood
- How Dr. Singh diagnoses and analyzes leaky gut
- Interventions for leaky gut, including colostrum serum-derived bovine immunogloblins, spore-forming probiotics, and zinc carnosine
- Pervasiveness of glyphosate
- How stress and unhealthy attachment styles can affect an infant’s gut microbiome
- Viability of precision prescriptions
- Why probiotics make some patients’ symptoms worse
Dr. Marvin Singh is an integrative gastroenterologist in San Diego, California. He is a diplomate of the American Board of integrative medicine, and a board-certified internist and gastroenterologist.
He was trained by Dr. Andrew Weil, a pioneer in the field of integrative medicine. Dr. Singh is currently a voluntary assistant clinical professor at UCSD in the Department of Family Medicine and Public Health; prior to this, he has been a clinical assistant professor at UCLA and an Assistant Professor at Johns Hopkins University.
He is one of the editors of the textbook of Integrative Gastroenterology, 2nd edition, which should be available in August 2019. He is a published author, a member of the Mind-Body Green Collective, and noted speaker, having recently spoken at the last few A4M Meetings on Integrative Gut Health.
He is passionate about using cutting-edge tests and personally designed protocols to develop a truly individualized plan based on genetics, microbiome, metabolism, and lifestyle.
Dr. Kara Fitzgerald: Hey, everybody. Welcome to New Frontiers in Functional Medicine, where we are interviewing the best minds in functional medicine. Today, of course, is no exception. I am really excited to be talking to Dr. Marvin Singh. Let me give you a smidge of his background, and we’re going to jump right in.
But I do want to say, before we jump in, if you are enjoying these podcasts and … Actually, I hear really lovely bits and pieces from you all, all the time. I just appreciate so much your feedback. If you are so inclined to swing over to iTunes and leave us a review, I would be most grateful.
All right, let me talk a little bit about Dr. Singh. He, after completing his residency in Internal Medicine at the University of Michigan, and going on to complete a fellowship in Gastroenterology/Hepatology at Scripps Clinic, Dr. Singh went on to become an Assistant Professor at Johns Hopkins and UCLA. He’s also an Assistant Clinical Professor at UCSD, actually currently he is.
He enjoys collaborating with scientists and researchers to learn about new technologies, and we’re going to pick his brain on that today. He’s a contributing faculty member at Andrew Weil Center for Integrative Health, and he completed a fellowship in Integrative Medicine there as well.
He is on the American Board of Integrative Medicine. He’s speaking with A4M. He educates other physicians, optimizing gut and whole health. He’s an early adopter to many of the emerging technologies that we have, including artificial intelligence. We’ll be picking his brain on that, especially how he’s bringing it into gastroenterology. What else?
This is what prompted our paths to cross in the first place, Dr. Singh, you are editing Oxford University’s second edition of Integrative Gastroenterology with Gerry Mullin. I’m contributing a chapter with Nikky Contractor to your book. So that’s how we originally met. It’s about to be out, right? It’s almost hot off the presses.
Dr. Marvin Singh: Yeah, yeah. Thank you for that awesome introduction, by the way. Yeah, the book will be out, we hope sometime in September. Perhaps late September. Not very far along.
Dr. Kara Fitzgerald: Awesome. Folks, we’ll definitely have it in the newsletter. We’ll give it a really big shout out. It’s exciting, exciting. Really good work, Dr. Singh. I know you and Gerry Mullin have just been working on this forever.
Dr. Marvin Singh: Feels like it.
Dr. Kara Fitzgerald: Serious labor of love. Yeah. But it’s just quality content, and I know clinicians are going to benefit from it quite a bit.
You’re a gastroenterologist by training, but you are just an early adopter to all this new technology that clinicians have available to us. I want to hear about that, and how you’re bringing that into gastroenterology, and actually you’re leapfrogging even, you’re practicing whole person medicine too. But let’s just go back and talk about A) your journey of getting into medicine, and then specifically moving into integrative medicine. Was that on your radar back when you were getting your pre-meds, or was it always something that you were thinking about? How did you get to where you are today?
Dr. Marvin Singh: Yeah, not at all actually. I’m a pretty conservative guy, and grew up even very conservatively, education wise. Went to medical school and did residency in Internal Medicine at the University of Michigan, which is a very good top-level hospital, but very conservative hospital as well. When I finished my GI training, and got into practice, I joined Johns Hopkins as faculty, which is another very, very top-level institution, which I have a lot of respect for, but also conservative as well.
I went into private practice after my tenure at Hopkins. I was still a young doctor and I started to feel a little bit lost in my own journey as a provider, felt like …
Dr. Kara Fitzgerald: Why is that?
Dr. Marvin Singh: Felt like we have a lot of tools that we can use to help people. If somebody is dying, or they’re bleeding in the hospital, we can save their life. If somebody has cancer, we have chemotherapy. We have these things, but the majority of people coming to the office, the people that are coming to the office are often people that have been bouncing around from doctor to doctor, with chronic problems, chronic symptoms that just won’t go away. They just kept getting pushed around from place to place. I felt lost.
I guess I took that personally as am I even doing what I’m supposed to be doing? Should I even be a doctor? I had this moment where I questioned maybe I should just go open a bagel shop somewhere or something, literally. I was a little lost in my early career. I was a good doctor, a good gastroenterologist, but I just felt like something was missing there.
My wife had always been the one who was more into integrative functional stuff. She says, “Why don’t you just take a look at some books on Integrative Medicine?” I was like, “No, no. This is a waste of time,” for a while. Then eventually she just went and bought the first edition of the Integrative Gastroenterology book for me, and she said, “Here, just look at it.” I begrudgingly looked at it, and I guess this is a lesson to all the guys out there, listen to your wives.
Dr. Kara Fitzgerald: It’s as amazing. Good for her. Good for her.
Dr. Marvin Singh: I looked at it. First place I went, I said, “Okay, let’s see what they say about IBD because that’s a big thing. Let’s see what they say about IBS.”
I see this book, looking at the chapters, I’m reading it. Sounds very interesting. They’re sighting literature, they are evidence-based. Then I look and I see the editor of this book is Gerry Mullin. I say, “You know, Gerry was one of the only guys at Hopkins that actually befriended me when I was a faculty.” Incidentally, I didn’t know anything about this integrative stuff.
Then I emailed him. This was a true story. I emailed Gerry and I said, “Hey, I was looking at the book, and this is what’s going on. What do you think?” Then we spoke and he said, “I think you should look into Andy Weil’s fellowship in Integrative Medicine.” I looked it up, and I thought, “This is interesting.” I just took a leap of faith. That was the point where I said, “Let me just see where this takes me,” and I signed up.
I went. Started doing the learning. I went for my first residential week, and I was doing yoga, I was doing Tai Chi, I was learning about herbs, I was learning about nutrition. It was just like, “Whoa, what is all this stuff?”
Dr. Kara Fitzgerald: Were you open at this point, or were you still a little bit like …
Dr. Marvin Singh: I was opening. But this just blew the door right open. I was like, “Whoa, what is thi … ” I came back and I felt like I just had a complete reboot of my whole body, my life, how I even felt personally. I was excited. Then I told Gerry, “This is awesome. Thanks for telling me.” Then he says, “Okay, since you like it so much, let’s have you write a book chapter with me.”
So we wrote a book chapter on the integrative environmental medicine book on chemicals, and toxins, and the gut. That just really opened my eyes to all the literature. I’m like, “Wow there is so much literature out there? Why aren’t people talking about this stuff?”
Dr. Kara Fitzgerald: Yeah, that’s right. Right, that’s right.
Dr. Marvin Singh: That lit my fire. Then I started using some of this stuff in my own life.
Dr. Kara Fitzgerald: That’s so exciting.
Dr. Marvin Singh: As soon as I got a handle of it, within about three or four months, I lost 30 plus pounds. When you apply that to your own health and your own life, and you see the benefits in that, it just exponentially excites your passion.
Then later on, I was offered the opportunity to co-edit the Integrative GI book, second edition, which is the book you are referring to. I find it really funny that the book that actually brought me into the field is the one that I am now an editor of.
Dr. Kara Fitzgerald: I know. That’s amazing. That’s a great story.
Dr. Marvin Singh: It’s funny how life works.
Dr. Kara Fitzgerald: It’s really funny. Gerry was the only nice guy. He’s just such a good guy….
Dr. Marvin Singh: There are other nice guys. I shouldn’t say that, but he was the nicest guy to me at that time.
Dr. Kara Fitzgerald: God, little did you know.
Dr. Marvin Singh: We are very good friends now.
Dr. Kara Fitzgerald: Yeah, he’s a good egg. He’s a really good person. Just thinking through what you’ve told me, you’re clearly good at heroic gastroenterology. You can get it done, right?
Dr. Marvin Singh: Yeah.
Dr. Kara Fitzgerald: You can, and that’s what you learned. But then you’re in practice and you don’t get to do that every day. In fact, you’re actually probably suppressing symptoms with proton pump inhibitor, or whatever you’re doing, you’re attempting to shut things down. But people are clearly not getting better early in your career, and you went through what I remember my existential philosophy professor said, “The ontological abyss.” Like, “Who am I?” You’re like, “What am I?”
Dr. Marvin Singh: Yeah. You can see, I guess I have this … Now you can see where my career path has taken me. I realize that there are two kinds of doctors. There’s the kind of doctor that can take care of you when you’re sick, and you’re about to die, and you need help. Then there’s the kind of doctor who wants to keep you from getting to that point in the first place.
Right now, I do both. That’s what exciting to me, because it’s nice to have a variety. I guess it keeps my brain thinking. They call me when I’m on-call in the hospital, somebody’s vomiting blood. They’re going to need a PPI because we want to save their life. We’re not worrying about magnesium deficiency at that moment, we want them to not die. We’re going to take care of them.
But then after that time period, then I can help them get off the PPI so that they don’t develop some of these chronic issues and symptoms.
Dr. Kara Fitzgerald: That’s a great. Okay, I want to actually talk to you a little bit about both hats. But I also am curious, just briefly, you turned your own health around. I’m assuming that you’ve influenced your wife, or your wife clearly influenced you. I know you’ve got two young kids at home as well. What were some of the things that you did that prompted you to sit up and be like, “Wow. There’s something to this integrative medicine”? Did you do an elimination diet, you start a probiotic … Just out of curiosity?
Dr. Marvin Singh: Yeah, it’s really funny. Obviously I was a little overweight, I had fatty liver, my liver enzymes were elevated. That’s part of my story. I was also worried about my own health because I have family history of dyslipidemia and coronary disease. But at that time, as a doctor, I thought I was doing the right things.
I’m eating healthy because I’m not eating a burger at lunch like everybody else is, from Wendy’s, for example. I’m taking a Coke Zero, a bag of low fat chips, and a sandwich. I’m not eating the donuts at work. That’s good right? So I’m healthy. But this is the farce that many of us live inside of, even doctors.
Dr. Kara Fitzgerald: You should mention what kind of nutrition training you did get as a gastroenterologist.
Dr. Marvin Singh: Very little. I’m the GI, right? You would think that we have this intensive nutrition training about what is this, and what is that, and really not. It’ll have a couple of lectures maybe on tube feeds. Just impractical stuff for day-to-day basis.
I really learned all this stuff from the fellowship. Then what the fellowship did was not give me volumes and volumes of knowledge. It gave me a lot of knowledge, but then gave me the motivation to go out and learn more. I’ve read hundreds of books since then. Now I’m reading about transcendental meditation, I’m reading about quantum theory, I’m reading about nutrition, I’m reading about the origin of man. I’m reading about all these kind of things because now I realize that all of these different pieces of knowledge, while they may seem unrelated, really are all related to the same thing, which is how to be healthy and well, and live long because that’s what we want ultimately.
Dr. Kara Fitzgerald: Geez, I love it. That’s a really lovely story.
What are some of the books that are jumping out? What would you recommend? Our audience, a lot of the folks listening to us are actually clinicians.
Dr. Marvin Singh: Providers.
Dr. Kara Fitzgerald: Yeah, but they’re not that different from you. A lot of folks who are transitioning into integrative/functional medicine from being really superb doctors in the greater medical model, now zeroing in. There is a good group of those folks with us. I’m sure your story resonates loudly for many.
Just out of curiosity, Marvin, what were some of the key books that you might suggest?
Dr. Marvin Singh: One of the really cool books that I read just lately was called Sapiens. I don’t know if you’ve heard of that one.
Dr. Kara Fitzgerald: Yeah, I have.
Dr. Marvin Singh: That’s a really good book because we often talk about how did our ancestors eat? Eat like your ancestors. Do this and do that. People come up with all kinds of theories, but I was like, “I want to actually read a book about the history of human beings, and how we actually came to be.” It’s really not what a lot of people proclaim that it is. That was a good book.
One of the most influential people, I always tell people in my thought process and how I look at people was actually Dan Siegel, still is Dan Siegel. I don’t know if you’re familiar with him, he’s a psychiatrist. One of the best books that I read was Mindsight, M-I-N-D-S-I-G-H-T. Then he has another book called the Mind, after that. Those books were very influential to me, and your like, “Why is a gastroenterologist reading psychiatry type of book?” But there is a huge mind-gut component. How people think, and act, and behave, and feel affects gastro intestinal symptoms. We actually now know that it actually affects the microbial ecology in the gut.
Learning about where some of these thoughts and feelings might come from, and helping people understand why they feel certain ways, and how to work and adapt to that, and reprogram how they think can actually make a substantial impact on how they feel from a GI perspective, and whole body.
One of the things that helped expedite my weight loss was actually mindfulness and meditation. You asked me what I did with my diet, and health and stuff. One of the first things I did was the obvious, got rid of the sodas, got rid of the extra carbs, cleaned it up, started eating only organic, started pushing a lot of the right vegetables, started using flax and chia in smoothies. The things like that, that seem common sense, but I didn’t know. I was a doctor, I still didn’t know. Then the weight started coming down.
I think I felt like I hit a plateau a little bit, maybe around 15, 20 pounds range. Then I knew about the mindfulness and the meditation, and all that stuff, but then I started really going a little bit harder on that. Then I felt like I just started coming down.
The stress response, modifying stress is actually a huge component. We talk about it a lot, but it actually can affect your weight. If you’re doing all these other things but you’re stressed out all the time, and you’re not reducing stress, you’re not taking the time to be present, that can actually hold you back, and so can sleep. We always talk about how important sleep is too.
Dr. Kara Fitzgerald: But you actually experienced those importance of …
Dr. Marvin Singh: Personally. Yeah.
Dr. Kara Fitzgerald: That’s really fabulous. I’m sure that …
Dr. Marvin Singh: We were talking earlier about how I got into personalized medicine. Now that I’m telling you this story, I didn’t really realize, I didn’t explain to you. Now you probably understand how I came to this point in my life, in my career, because I started doing nutritional genetics tests on myself, I started doing microbiome tests on myself, I started doing food sensitivity, chemical sensitivity tests on myself, I started modifying my behaviors based on that.
Dr. Kara Fitzgerald: Yeah, yeah. It makes sense.
Dr. Marvin Singh: Then I saw that this stuff, once you actually use the information that you know about your body can actually help you refine your thought process on your own health because nobody can tell you, “Yeah, drink four cups of coffee a day because it’s good for fatty liver,” because I have fatty liver. But I have gene SNP for caffeine. So if I do that, I might have a higher risk of hypertension later on in life.
You want to understand how to modify your behaviors based on what you’re made up of, because nobody can tell you that unless you know your information. Everybody’s different.
Dr. Kara Fitzgerald: That’s right. That’s right. No, it’s exciting. Okay, that makes a lot of sense to me why you really zoomed out into this personalized medicine, into the thick of the personalized medicine revolution out there in California.
Let me think, there was another question that I wanted to ask you in this world. Go ahead and feel, it’s fine for you to if you want to mention any labs that you’ve used, if they’re going to be useful to clinicians. There’s a lot of genetic assays out there. In fact, I know you’re already using some epigenetic stuff. You and I talked about that, but stool testing. If you want to mention things that you are using in clinical practice, that you think will be helpful to our audience, by all means, do.
You started to … Oh, I know what I was going to talk to you about, Marvin. Going back to the gut-brain access, we are what we eat. I think the data, and you’re way more current on this and deep in this than I am, but the fact that we can produce plenty of neurotransmitters in our gut that will influence what’s happening in our central nervous system, or we can produce precursors, or even endotoxins that will influence neurotransmitter production and behavior, and feelings, and cravings, etc., that the gut-brain access, we are what our gut bugs eat, I think basically is a pretty reasonable statement.
Dr. Marvin Singh: Exactly.
Dr. Kara Fitzgerald: Would you concur?
Dr. Marvin Singh: Yeah, you are not what you eat, you are what they eat.
Dr. Kara Fitzgerald: Yes, and are they happy or not?
Dr. Marvin Singh: Actually Gerry said that. That’s Gerry’s quote. I won’t steal it.
Dr. Kara Fitzgerald: That’s awesome. You’re not what you eat, you’re what they eat.
Dr. Marvin Singh: Yeah. Yeah, that’s very true. That’s very true.
Dr. Kara Fitzgerald: There was a blog I wrote some years ago. I had a patient. Well, we all have patients who repeatedly have an incredibly difficult time moving through their cravings, detoxing from sugar and simple carbohydrates. This patient repeatedly, despite her best efforts and how much better she would feel when she would transition for a day or so, she would inevitably relapse in a sugar binge of one form or another, and she would be a different person.
I remember one day, she threw herself into my office, and she had this look of distress and guilt, and proceeded to tell me what she had eating. I said to her, “Who am I talking to? You or your gut bugs? Who’s in the driver seat?”
Dr. Marvin Singh: You said that?
Dr. Kara Fitzgerald: Yeah, I did. I did. Yeah, I blogged about it and she later got in contact with me, and she’s like, “Hey, that sounds really familiar.” But it’s true. It’s like, “Are you the marionette for your bugs? Who’s running the show here?”
The other thing I’ll say, and then I want to just get back to you, is one of the things I have observed is that when people can let themselves go through that detox, the changing of the microbial guards from full tilt sugar carb, whatever their addiction is, to cleaning it out and changing the ratio of microbes, that the cravings will subside, and they’ll develop some resistance potential. Is that what you’ve seen?
Dr. Marvin Singh: Yeah. Even in my own personal health. If you say, “Here, take a sip of Coke or Coke Zero,” like I used to have in lunch every day, it’s disgusting to me. I don’t even like it. It’s not even a thought on my mind like, “Oh, I wish I could have a Coke.” You definitely do change. My cravings now are for asparagus and Brussels sprouts.
Dr. Kara Fitzgerald: Yeah, that’s right. Yeah, that’s right. That’s pretty cool.
Dr. Marvin Singh: It’s funny. It’s not like I’m just saying that, it’s actually this is the truth. Ask my wife. If I had to pick what I would eat, I say, “Do you have any asparagus or any Brussels sprouts?” That’s what I like, these days.
Dr. Kara Fitzgerald: That’s awesome.
Dr. Marvin Singh: Eating is not just a microbial experience, it’s a whole-body experience. I was just reading some literature recently. We get into this in the Integrative GI book that’s coming out. When you eat, the process of eating doesn’t just start when the food is already chewed up in your stomach, it starts with the smell, the appearance, the taste when you put it in your mouth, what happens when it goes down to the digestive tract, the chemicals that are released from the microbes and from the gut lining.
You know what, all of this is packaged and stored, you can imagine, as just a little bundle in a part of your brain as a memory. I think this is where the whole idea of comfort foods comes from. When you feel like, “Oh, I’m sad,” you’re not thinking about this consciously. You can’t really remember it necessarily like, “Oh, when I was three years old, and I fell of my bike, and I was really sad and crying, my grandma made me mac and cheese, and that made me feel better. Now I’m 20-years-old, and every time I’m sad, I want to eat mac and cheese because that makes me feel better.”
The brain is such a fascinating organ that it remembers, and it’ll trigger. It’ll say, “Oh, you’re sad. Oh, let me go to this bundle memory. This bundle memory says mac and cheese. Okay, because mac and cheese did this to you inside your body, and this is what you’re feeling that you need, so let’s make you have mac and cheese.” Now I have a craving for mac and cheese. This is how it works. It’s a whole body experience, and it’s bundled in these little packages of information in our brain, and tucked away for the day that you need it.
Dr. Kara Fitzgerald: I can, in my practice, guide people through that detox journey. I usually say, “Listen, get yourself a ton of … Bust out your Netflix subscription, curl up somewhere and just let yourself feel lousy for a little while as you detox off of whatever your food addictions are.”
Just listening to what you’re saying, would you add anything to that? What’s your prescription when you’re transitioning them onto a better, a healthier way of eating? How do they get through it?
Dr. Marvin Singh: Yeah, I usually will never tell anybody, “You got to go from zero to hero.” That’s one of my saying. We’re not going to go from eating Wendy’s every day to eating Brussels sprouts all day long. It’s a process, and it’s a gradual process. There’s no rush because this is why we call it lifestyle medicine. It’s for your life. It’s not for 10 days from now. This is not a diet to lose 10 pounds for the wedding, this is a way of eating for your life.
I coach people and I say, “If you can make one change a week, then that’s good. If that means instead of ice cream in the night time, you’re going to have mixed berries with some cinnamon sprinkled on top, and some walnuts in exchange. Then that’s progress.”
What you find is that when they make the one change per week, they start noticing how they feel better after a few weeks. Then you may have told them one change per weeks, but they’re actually now doing two or three changes per week. They feel more energetic, so they want to exercise. They started exercising, then they start sleeping better. They are exercising and sleeping better, they say, “Oh, what about this meditation thing you talked about. Let me try that now.” Then they do that. Do you see how everything snowballs in the right direction instead of snowballing in the wrong direction.
Dr. Kara Fitzgerald: Yeah, right.
Dr. Marvin Singh: Then they forgot that they really even liked ice cream at night.
Dr. Kara Fitzgerald: Right, right. Well will you prescribe a full elimination where you’re pulling somebody off of the top antigenic foods and then do a challenge? Do you use that in your practice?
Dr. Marvin Singh: Yeah. While some people have symptoms to certain things, and some people don’t have symptoms to certain things, and there are certain foods that you want people to avoid in general, so it really depends on who the person is and what’s going on with them, and if they have any particular concerns.
There are a lot of people who want to optimize their health, and they say, “I’m healthy. I have no problems. I don’t have any symptoms.” But you got to work through some of that because no matter how healthy you think you are, there are still issues inside your body, and the way that the biology is working, most likely, because I don’t think there’s a perfect person out there.
Dr. Kara Fitzgerald: No. Probably not. No, I’m just kidding. Not the biohackers out there in your neck of the woods.
Okay. Listen, I want to talk a little bit about your practice and how you created it, and then I want to talk your personalized lifestyle medicine practice. Then we’ll move over and we’ll talk a little gastroenterology to wrap up here.
So you’re doing … Through your own experience, which makes a whole lot of sense to me since you just walked us through that you really want to practice full tilt systems medicine. I love it, it’s really inspirational. I think it’s inspiring to folks listening to us, especially because you really came from very mainstream gastroenterology/academic medicine. Bravo you.
How did you hang out your own shingle? From what I understand, you actually created your own practice in personalized lifestyle medicine/systems medicine. How did you do it? Are you accepting insurance? What does it look like? What does the model that you’re using look like? Then I want to talk a little more granular about some of the tools you are using that we might be into.
Dr. Marvin Singh: Well we’re working on the process right now. What I’m doing right now is within my current practice, and we’re shifting towards me opening a separate entity to do this out of.
Unfortunately, the way functional integrative medicine works, insurance payers don’t pay for that. They don’t pay for many of these tests. They’re not going to pay for whole genome sequencing, they’re not going to pay for 90-minute evaluations and things like that. That’s just the nature of the world we live in right now. I wish it was, but insurance is very limited, as far as what you can do. Some basic tests, whenever we can, we try to use things.
For example, the Cleveland HeartLab is now purchased by Quest, so that’s actually turned out to be a pretty cool thing because anybody can go to Quest really, and you can get some really cool NMR lipid panels, and check your TMAO level, and all these other things there. Even MTHFR now you can do, for a pretty good price. Their insurance covers that because it’s a Quest lab. Whenever we can, we try to use those things, but many of these tests, they don’t take insurance either.
Dr. Kara Fitzgerald: Yes, that’s right.
Dr. Marvin Singh: One day, maybe.
Dr. Kara Fitzgerald: Yeah. Right, right, right.
Okay, so you’re practicing in a larger multidisciplinary setting. Is where you’re practicing primarily in the insurance model, or is it outside of it?
Dr. Marvin Singh: Yeah, so my GI practice, my regular GI practice is just like any other doctor’s office you walk into. It’s just your standard insurance-based GI practice, and I do all the precision wellness on the weekends, and after hours.
Dr. Kara Fitzgerald: Ah, got it.
Dr. Marvin Singh: I have my own assistant for that. It’s a little bit of a different setup. That’s how we do that. Because it’s too complicated for me just logistically to interweave a 90-minute visit in the middle of 20-minute follow-ups. It’s a totally different ballgame.
Dr. Kara Fitzgerald: Yeah, yeah. Sure.
Dr. Marvin Singh: Then I also take calls for the hospital. I keep my feet wet with regards to really acute care medicine. I get called in the middle of the night if there’s a food impaction, or a variceal bleed. I’m really a man of all trades. I do it all.
Dr. Kara Fitzgerald: That’s amazing. You’re working a lot of hours, it sounds like these days.
Dr. Marvin Singh: Yeah. Making sure I get my seven hours of sleep though.
Dr. Kara Fitzgerald: You’re doing a lot. Good. Good. Good for you. Okay, so you’re just piecemeal moving into personalized medicine when you can fit them in.
Dr. Marvin Singh: Yeah. It’s not at the point where I’m doing that 100% because I feel that I need to continue doing regular gastroenterology and learning about the latest drugs, and techniques and things like that because that makes it more pertinent and helps keep me well rounded because integrative medicine doesn’t mean you forget all the traditional stuff. Somebody could be coming to you with chronic abdominal pain, being passed around from provider to provider, and you realize that, “Nobody did a CAT scan. This guy has pancreatic cancer.”
It’s good to keep that conventional hat on sometimes and forget that some people may come to you with things that may not sound like they are a real problem, but they actually might. I have seen plenty of people, particularly as the years, more recent, presenting with severe problems, like people in their 30s with colon cancer.
You wouldn’t ordinarily think somebody in their 30s having abdominal pain, and cramping with a little bit of bleeding. You would say, “Oh, you have IBS with constipation and hemorrhoidal bleeding. They could go around there to there, doctor to doctor, and eventually … If you didn’t think, “Maybe this guy needs a colonoscopy, and they have a colon cancer,” then you didn’t think about it. You missed it.
If they did a colonoscopy and there’s nothing there, then that’s great. Then I can talk to them about how their philosophy is with regards to their management. Do you prefer natural treatments? Do you not care? Do you not want natural treatments? I can go either way, whatever the patient wants because the patient is always the boss.
Dr. Kara Fitzgerald: Yeah, right. I got it.
I want to just finish up with the personalized medicine clinic that you’re evolving here. Any tests standing out, any interventions, anything you want to just mention that you’re particularly excited about that our listeners might into hearing about?
Dr. Marvin Singh: Yeah, I’m really excited about this one test called Chronomics. This I think we briefly talked about. They are a company in London that they have two kinds of tests. One is whole genome sequencing with epigenetics, and then they can do just the epigenetics where they’re basically looking at methylation across the genome, and helping you understand what your biological age is, as opposed to your chronological age, based on your birthdate.
If you chopped a tree down, and you looked at the rings on the tree, you can proximate how old the tree is. This is a way that we can do that with our DNA, which they feel is much better than looking at telomeres, which is what many of us may be doing. That’s what I had been doing as well, so I’m moving towards that.
There’s a company here called Sun Genomics in San Diego actually, that is doing microbiome analysis, and helping you understand where in the microbiome you may have some deficiencies, and helping you create a precision probiotic for that.
Dr. Kara Fitzgerald: Oh, is that right?
Dr. Marvin Singh: Yeah. There’s a lot of exciting companies. All the time I’m hearing about new companies, and new tests and things like that. I think what’s awesome in this whole movement towards precision medicine is that it’s really sparking the innovative flair among scientists to try to figure out what else.
There’s a company called Ixcela, that I’m starting to work with. They’re looking at microbial and microbial-related metabolites in the blood. They say, “You don’t need to a microbiome stool test because what’s most important is what the metabolites in the blood are from the microbes because that’s what’s going to tell you how the microbes are working.”
My approach is that I don’t just say, “Okay, well, then that’s the one test I’m going to do, and my whole program revolves around one test.” There are and can be discrepancies between two different tests that are looking at the same thing. What’s important is to look at a variety of different tests, perhaps build themes, correlations and patterns so that you could understand this really is a picture of dysbiosis, this really is a picture of leaky gut and inflammation.
Based on this person’s life, and their experiences, and what medications they’re on, and what diet they’re on, what their family history is, what toxins they are exposed to, what their levels of toxins are, this is how I’m going to guide them, because this is what I’m going to tell them what to do, how they’re going to eat, how they should exercise and blah, blah, blah, that kind of stuff.
Dr. Kara Fitzgerald: Well, I definitely agree that well A) we really need to kick the tires of some of this new technology and really try it out. My experience is that you can generally negotiate some sort of a trial with the lab, if you reach out and let them know you want to bring it into practice so you can try it out and really vet it with your patients.
But you’re right, Marvin. You and I were just talking about this earlier, we are cutting the edge right now. Some of these things are going to stay with us, and evolve, and expand. Some of the interventions we’re using now are going to fall to the way side, when we realize they’re not quite as spectacular. Who knows, maybe that lab that you just mentioned, was it Ixcela? Maybe they’ll be right, that we’ll say, “Yeah, we don’t really care about the microbiome.”
I find that a little bit hard to believe, that we’ll only care about the metabolites produced by said microbiome. I think it would be part of the conversation.
Dr. Marvin Singh: A lot of us say it doesn’t matter which microbes are there, it matters what’s happening inside the ecosystem.
Dr. Kara Fitzgerald: Yeah, that’s true. That’s true. That is true. But those microbes, their activities change pretty quickly.
Dr. Marvin Singh: Exactly. Well that’s why it’s not just a static test. You could check your whole genome and then you never have to check it again because your genome is your genome.
Dr. Kara Fitzgerald: That’s right.
Dr. Marvin Singh: It’s the microbiome that’s the thing that changes all the time.
Dr. Kara Fitzgerald: That’s right. That’s right.
What are some of the interventions that you are prescribing, that are really foundational? I want to just, before you jump in, I want to say, I just want to ask you because I’m curious. Patients and clinicians alike are really pretty gaga about spore probiotics. There’s a lot of new spore probiotic companies coming out. I definitely will hear some good outcome from patients with various preparations.
I know the literature on spore probiotics is in its infancy. Probiotic literature in general is in its infancy, although Metchnikoff was writing about it way back in the day. But what do you think? What are your thoughts on probiotics and comment on spore….
Dr. Marvin Singh: I think one of the leaders in spore-based probiotics is Microbiome Labs, with the MegaSpore probiotic that they have. They are driving the literature as well. Kiran Krishnan has helped produced papers about how spore-based probiotics can help with intestinal permeability, or leaky gut.
When I look at which companies I use for products, or tests, I try to look at the quality of the science and scientists behind the product. That company, Microbiome Labs, is one of the ones on the forefront with regards to gut health as well, so I use a lot of their stuff as well.
Dr. Kara Fitzgerald: How are you analyzing leaky gut? How are you diagnosing that?
Dr. Marvin Singh: That’s a good question. I look at a couple of different things to get an idea. I don’t just go based on one test alone, so there may be a stool exam where we’re looking at zonulin, and other inflammatory markers. I may look at metabolomic metabolites from certain tests, like we just mentioned. Then I like Cyrex Labs. I use Cyrex a lot. They look at a lot of the antibodies too. They have a whole intestinal permeability screen.
Then I see that if all different components are giving me this feeling for leaky gut, then I say, “You have leaky gut.” If you got maybe half a marker in one place and everything else looks pretty solid, then it’s like, “Maybe not.” Doesn’t mean you don’t have problems, but it may not be related to that.
Everybody, we have a focus on gut health, and healing the gut, and helping have a more diverse microbiome, but in some people that have more flagrant leaky gut, then obviously the protocol for supplements and things like that, that you put together for them might be a little bit more intense around intestinal permeability because you have something that you need to fix.
Dr. Kara Fitzgerald: Well let’s talk about that. What would be your protocol around somebody that you’ve fairly strongly identified intestinal permeability?
Dr. Marvin Singh: We use spore-based probiotics like we talked about. One of my secret things is serum-derived bovine immunoglobulin. A lot of people don’t even know about that, believe it or not, but that’s a great product that I find very helpful with a lot of people.
Prebiotics, there’s zinc carnosine.
Dr. Kara Fitzgerald: What are your prebiotic go-tos?
Dr. Marvin Singh: Microbiome Labs, they have this whole protocol for healing leaky gut. They have a prebiotic supplement as well, so I like that. Sometimes people don’t want to take too many different things, so we may find a symbiotic for them to use, which is a probiotic with prebiotic mixed in together. There are things like that, that we can use. We use L-glutamine. Sometimes we also use bovine colostrum. I use that a fair amount as well in my practice. I don’t know if you much of that at all or not, but …
Dr. Kara Fitzgerald: Colostrum?
Dr. Marvin Singh: Yeah. I find that can be pretty helpful in people with their symptoms. A lot of the refractory people that have refractory gut symptoms report feeling much better when they use that.
Dr. Kara Fitzgerald: Colostrum verus serum-bovine immunoglobulin or either?
Dr. Marvin Singh: Yeah, sometimes I use them both actually. They’re coming from two different places. Although, they both have immunoglobulins in them.
Dr. Kara Fitzgerald: Yeah, yeah. We underuse colostrum here. I think just because we’re … We do a lot of … We see so many food allergy and food sensitive patients here. We’re a bit of a focus, just because that’s what I teach. I’m in the immune module at IFM, so we just tend to have a lot of allergy folks here. So we’re pulling them off of dairy. To that end, we’re fairly conservative around using colostrum, although I think we are on the side of excessive caution. I completely agree with you in that I think it’s a spectacular product, but we do tend to just get the immunoglobulin product instead.
Listen, you’re thinking a lot about toxins, and I’m just curious what tests you’re using to evaluate and what are evaluating? Organotoxins? Metalotoxins? What are you doing?
Dr. Marvin Singh: I like Great Plains Lab. I think they have a lot of good tests. I don’t know what you use, but they check for mycotoxins, they do metals, and nonmetals and things like that. I find that a good, at least first-line type of test to get an idea of what the toxic burden is. I know there’s a Genova test that people like as well for toxins. I think those are good places to identify.
One of the main things in finding toxins from my perspective is at first identify where the toxin is coming from.
Dr. Kara Fitzgerald: Sure.
Dr. Marvin Singh: I had somebody with three different mold toxins, very high. It turns out that the boat that they have was just chock full of mold in the ceiling because there was a pipe. It was a plumbing pipe, I guess, that ran across the top. It was a big boat. Insulation eroded, and the pipe was leaking, and the whole thing just filled with mold. The mold inspector said that even the air quality inside the boat was greater than 100 times what you would even think was high.
Using these tests can help you clean up your environment until you can identify where problems are coming from. Somebody I had, had a very high lithium level. I was like, “Are you taking something with lithium?” “No, no.” She did have a little bit of a tremor, actually. Then a couple weeks passed, and she said, “You know, I was looking at these mineral drops that I take, there’s lithium in it.” I said, “Oh, you got to stop that.” She stopped taking that, and a couple weeks later the tremor went away.
Dr. Kara Fitzgerald: Geez, that’s so fascinating. It must have been an inappropriate batch. Usually they’re pretty conservative with lithium, in an over-the-counter mineral combination.
Dr. Marvin Singh: Yeah, I know. Maybe she was taking too much, I don’t know. At least we can help you do that.
I talk to them about using things like NAC, milk thistle, vitamin C, glutathione, sauna. We talk about all of these things as well, too, but it helps you understand your environment. I think people get a great appreciation for how things around them can affect their health, because I think we take that for granted a lot too. You’d be surprised. Even if you think that you live near the ocean and you don’t have any toxic exposures, you’re going to have something. Something’s there.
Glyphosate is the craziest one. I check glyphosate, too. It’s probably one of the reasons why I started using Great Plains Lab because it’s very easy to run a glyphosate level with them.
Dr. Kara Fitzgerald: Yeah.
Dr. Marvin Singh: Even people that are like, “I am hardcore organic. Da, da, da, da, da.” Everybody’s got glyphosate. I haven’t seen anybody with a zero level. I’ve checked a fair amount of them.
Dr. Kara Fitzgerald: Yeah, that’s interesting.
All right, you know we’ve covered … I can continue to ping you with questions. I think just to wrap up, you had sent me this really cool paper on the monkey baby.
Dr. Marvin Singh: Oh, yeah. Yeah.
Dr. Kara Fitzgerald: You want to just share the monkey baby paper to take us home?
Dr. Marvin Singh: The famous monkey baby.
Dr. Kara Fitzgerald: Yeah, yeah, yeah.
Dr. Marvin Singh: This, I tell people, is one of my favorite studies to look at, but it’s not the nicest of studies.
Dr. Kara Fitzgerald: We’ll link to it. We’ll link to this. We’ll actually link to this and a lot of what you’ve referenced today in our show notes, folks.
Dr. Marvin Singh: Awesome. Basically what they did was they took infant monkeys, they looked at the microbiome of the monkey at the time they were born, then they separated the monkey from the mother, and then they looked at the microbiome afterwards. They found that the microbiome of the monkey, with everything else staying the same and with the microbiome with the monkey shifted towards having a pattern which we see in adult literature consistent with people who have mental health problems like OCD, anxiety, depression and things like that.
This really hits home the point. We talk about the first thousand days, and things like that, about the most important time for your microbiome’s development is within the first two and a half to three years. That’s very true because there is so many things that are happening. The computer is being programmed at that time, whether it’s related to stress, exposures, foods, all kinds of stuff. It’s just complete information download, and we don’t think, “Oh, it’s just a baby. They don’t know that this is happening in the background,” but they do know, and their body sense that, the brain sends messages to the gut, the gut starts formulating around that.
Then later in life, you wonder why does Johnny have anxiety. Well it’s because the parents were always fighting each other when they were young, and they didn’t think that they shouldn’t really fight as much in front of the kid, because the kid hears everything. They thought, “He’s just a baby. He doesn’t understand.” Stress at a very early age can certainly affect the microbiome, and can actually create changes in the microbiome at a vulnerable part of someone’s life, in the first couple years that can last them their whole life.
It’s not a death sentence though, by the way. I tell people that just because that infant monkey now has more of an anxious microbiome doesn’t mean that he’s doomed to be anxious his whole life. I think understanding that this is a possibility, that this can happen, that this is part of the process knowing about the person’s life and experiences, and where they came from and what environment they grew up in helps you as a clinician understand who they are.
This is going back to all the Dan Siegel stuff we were talking about in the beginning, helps you understand how they grew up, who they are, and what microbiome they could have potentially. Then helps you understand the importance and how much you would push some of the other lifestyle modifications outside of diet in helping them reprogram their gut microbiome so that they can have improvement in their mental health.
I have seen so many people just with change in diet, doing meditation and exercising, all these things that we’re severely anxious, even agoraphobic, didn’t want to go outside, a complete change in their mental status, in their health, and then it gets better and better as time goes on.
Dr. Kara Fitzgerald: In this arena, are you thinking about precision probiotic prescriptions. You were talking about that company earlier that does a individualized probiotic. We’ve certainly used custom probiotics. We’ll customize formulas for our patients.
I don’t know that we’re quite ready for primetime, these precision prescriptions yet, but do you see this as … Are you doing these precision prescriptions, and/or do you see this as being something that we’ll start using, that it’ll be a real viable intervention in psychiatric medicine?
Dr. Marvin Singh: Yeah, I think it could be. I think it could be a real viable intervention.
Like you were saying, we’re just cutting the edge. This is all very new and early stuff. We may learn things. Nothing individually is perfect, but we have some stuff that’s pretty darn good these days. If we have access to it.
I tell people, “You’re going to take a probiotic anyways.” “Oh, I need a probiotic. It’ll help my symptoms.” How are you choosing that probiotic? Based on what looks good in the store, on the shelf, or what you heard on TV, or on a podcast? How do you know that is actually what’s good for you? Have you actually felt where you take a probiotic and you actually feel sick from it? Why is a probiotic making you feel sick when this probiotic is supposed to make you feel well? That’s because everybody has a different microbial ecosystem. Everybody’s gut is different.
If we have even just the beginnings of technology that allows us to help us understand which microbes might fit best for you that are going to be better for your health, then why not? You’re going to take it anyways. That’s how I look at it.
Dr. Kara Fitzgerald: Well we’ll link to the monkey study, and anything else along these lines that you’re thinking about, we’ll link to the book, Integrative Gastroenterology.
You will be presenting at PLMI, Personalized Lifestyle and Medicine Institute in October. That’s Dr. Jeffrey Bland’s conference.
Dr. Marvin Singh: Yeah, I’ll be there in October. I just got an invitation to be at A4M in December in Vegas, so that’s another great conference, if anybody’s going to go to that. They have a lot of great speakers.
Dr. Kara Fitzgerald: That’s terrific. Well listen, Dr. Singh, it was just fabulous to spend this time with you. I’ve really enjoyed getting to know you. I think you have inspired a lot of clinicians today. I look forward to meeting you in person at PLMI in October.
Dr. Marvin Singh: Awesome. Thanks for having me.
Dr. Kara Fitzgerald: Thanks for joining me.
Dr. Marvin Singh: Appreciate it.
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