I’m so happy to be here with Dr. Vincent Pedre to dive into emerging science on the microbiome because as Dr. Pedre preaches: it all starts with the gut. In this podcast, Dr. Pedre shares extensive clinical pearls from his vast experience in functional gut health in an approachable and fun way as he drills down on possible causes of the challenging gut epidemic we clinicians see in the increasing numbers of IBS patients walking through our doors.
Dr. Pedre and I discuss how microbial diversity is the holy grail for reducing the risk of chronic disease, and how the gut disruptors of our time (including food and environmental toxins, chronic stress, our over-sterilized world and lack of time in nature) are leading to many of the health challenges we see today. We also review the impact of a diet high in fiber vs a diet high in fermented foods on microbial diversity and immune activation. And there’s more: we talk about how where we live matters when it comes to our microbiome, the health- or disease-promoting post-biotics (gut-derived metabolites), what an optimal diet would look like, and our ability to create stress resiliency.
It’s a lot — and I’m sure you’ll be fascinated by Dr. Pedre and find numerous valuable insights to support your own health and that of patients. As always, thank you for listening and please do leave a thumbs up or a kind review on Apple Podcasts or wherever you listen to New Frontiers. ~DrKF
Evidence-Based Dietary Approach to Improve Health and Stress Resiliency Through the Microbiome
Dr. Vincent Pedre believes “gut is the gateway to excellent wellness.” In this episode of New Frontiers, Dr. Pedre pulls from his years of research and clinical experience in the field of functional gut health to show how our microbiome is shaped by our diet, environment, and stress levels. Giving clear and specific examples of how to incorporate fermented foods, fiber and vagus nerve exercises into our lives, Dr. Pedre shows how we can positively improve microbiome diversity and stress resiliency to support digestion and immune regulation and reduce inflammatory markers in order to decrease the risk of chronic disease.
In this episode of New Frontiers, learn about:
- The optimal diet for gut health
- Importance of fermented foods and fiber for microbiome diversity and how much is needed
- Impact of chronic exposure to chemicals and toxins on our microbiome and overall health
- How chronic stress impacts our dietary and lifestyle choices and our microbiome
- Connection between the Western diet, chronic obesity, and epidemic of gut disease
- Negative impact on microbial diversity when we move away from nature
- Specific exercises to improve vagal tone and build stress resilience
- Similarities between antibiotics and pesticides when it comes to affecting the microbiome
Dr. Kara Fitzgerald: Hi everybody. Welcome to New Frontiers in Functional Medicine, where we are, of course, bringing you the best minds in functional medicine. And today is no exception. As you can see, I am sitting next to my good friend and colleague, Dr. Vincent Pedre. You know who he is. He’s been on the podcast before. But let me just give you a little bit of his background and then we’re going to jump into talking about his latest book. Dr. Vincent Pedre is the medical Director of Pedre Integrative Health, and he’s the founder of Dr. Pedre Wellness, CEO and founder of Happy Gut Life, LLC, and has worked as a nutraceutical consultant and spokesperson for NatureM.D. He’s also a functional medicine certified practitioner, and he has a concierge practice in New York City. He believes gut is the gateway to excellent wellness. And his new book, The GutSMART Protocol, features a 14-day personalized gut healing plan based on the GutSMART quiz. It’s the culmination of years of research and clinical experience as a functional gut health expert. Dr. Pedre, it’s really great to have you back on New Frontiers. Thanks for joining me.
Dr. Vincent Pedre: It’s a great pleasure to be back. Thank you for inviting me back.
Dr. Kara Fitzgerald: Absolutely. Well, I’m excited about your new book. I’m excited about the work you’re doing. I see you on Instagram. I mean, I’m not on Instagram a ton, but I mean, I am as a professional and my business is there, but when I go on, I just love what you have to say. I mean, you’ve just really honed an important message, not just for regular people. I mean, you do put it in plain language and you make your work funny and I don’t know, you’re just a natural performer, but you also have these pearls for clinicians. And as you and I were dialoguing, as you know my podcast is geared towards clinicians, we have a lot of regular people on it as well. And so I want to learn about the book. We’re going to cover what you did and you’ve got a lot of cool areas we’re going to drill down into, but I wanted to just get your thoughts on the fact that we’re in a really difficult gut epidemic.
I mean, there was a time early in our careers where treating gut health was as simple as pulling out gluten, maybe pulling out dairy, giving them a probiotic, it was pretty straightforward. And now it’s involved and people come back to us with repeat difficulties. We’re treating SIBO over and over and over, and we’re just in this new era. And I wanted to get your thoughts on that. And then also the solution.
Dr. Vincent Pedre: I think there’s a lot to say there, even from looking back in the ’80s, the ’90s, I know I’ve spoken to gastroenterologists that said they never saw as much IBS as they’d been seeing in the two 2000s. And these were people who were in practice since the ’80s. And I think we have to interlay that with what’s been happening to our environment, to our food supply, the availability of antibiotics, the possibility, because I know a lot of people who cross the border and go to Mexico and get their antibiotics just in case at the pharmacy where you don’t need a prescription and then bring them back and take them. But that’s the world we’re living in. Antibiotics are being over-prescribed. And the CDC has even said that. It’s even worse if you’re Hispanic or you’re African American, you’re more likely to get an antibiotic that you don’t need.
And there’s toxins, toxins in our food, pesticides, glyphosate is a big gut disruptor, a really big gut disruptor. I just did an environmental toxicity panel on a patient of mine who is a pilot and also works as a flight instructor. And he eats a very at home, his diet is pristine, organic, everything perfect. But then when he travels, he’s got to pick up things and pick up food, and sometimes he might be having meat and whatnot. And surprisingly, for someone that I’ve known is really healthy, his glyphosate level was super high.
Dr. Kara Fitzgerald: Wow. Oh, god.
Dr. Vincent Pedre: And honestly, if you had asked me to guess beforehand, this patient, knowing who he is, knowing his physique, knowing how well he takes care of himself, would you guess that his glyphosate level is high or low? I would’ve said it’s low. And so then we were there sitting during the appointment, just boggling our minds thinking, well, where is your exposure? And we started thinking, it must be the food that you’re picking up when you’re at the airport, the times when you’re not on your diet that you’re having bread or you’re having a slice of pizza. But just think of this is what most Americans are doing. And glyphosate is a big gut disruptor because it’s a chelating agent, chelates minerals, but it also acts as an antimicrobial agents, by doing that, it’s going to cause a dysbiosis, which then leads to leaky gut and all of the consequences thereof. I think we also can’t discount the effect of stress, and I think we have to look at stress from different levels.
It’s funny because there’s a commercial that ran in the 1970s, or I think it was the ’70s, about how the world was going to be a better place. And they had back then, computers filled an entire room and it was one computer. And it was saying how the future is going to bring less work hours, people are going to have more leisure. What has the internet and smartphones done? The complete opposite. People can never unplug, they’re working at nighttime, they’re checking email. I think we’re a hyper-stimulated society under a lot of stress and a lot of people, and there we can talk about it. There’s some studies showing that stress does affect the way that the makeup of the gut microbiome and the way the gut microbiome is behaving, but stress also affects our behavior. What do stressed out people do?
Dr. Kara Fitzgerald: They eat garbage.
Dr. Vincent Pedre: Yeah, but also I’m so stressed, I need a drink. So the end of the workday comes and they’re having their drink, maybe they’re having two drinks. You’re ingesting a socially acceptable major gut disruptor that causes dysbiosis, that increases leaky gut, that increases inflammatory cytokines. So I think that as a society, as we’ve moved, we’ve moved away from nature and our connection to nature, and we’ve moved into life of convenience and more of an urban life. I think with that has come a lot of these problems. I was also thinking, as you were asking the question, plastics, BPA.
I mean, BPA also is a gut disruptor and also increases the risk for autoimmune disease. All of these things. I was just thinking, I saw a company on Instagram yesterday that was saying they just got accepted into Whole Foods, and it’s a metal bottle water instead of a plastic bottle. And it’s almost like we’ve evolved so much into convenience and we’ve gotten away from where our food comes from. We’ve gotten away from nature, which is very important, we can talk about that in my experience, going to Africa and hanging out with the Hadza hunter-gatherers and how that influences and affects the gut microbiome and we’re over sanitizing. I think the overuse of hand sanitizers, the introduction of anti… It’s been shown that triclosan and antibacterial soaps can get absorbed into the body and then has effects on the gut microbiome.
Dr. Kara Fitzgerald: Yeah, I’m not sure. Yeah, I’m not surprised.
Dr. Vincent Pedre: And then of course, things like mold, environmental toxins that also affect the gut. I think that all of this adds up to an epidemic of gut disease that is not just limited to America. I mean, you can almost track gut disease with rising obesity rates, not just in the US but around the world. The entire world is becoming more and more obese as their diets in other parts of the world become more Westernized with highly processed carbohydrates, with lots of sugar, with sugary drinks. Now all of this I think is a factor in this epidemic of gut disease. When I grew up in the ’70s and ’80s, we rarely went out to dinner. And my grandmother lived with us, most of our meals were home cooked.
Dr. Kara Fitzgerald: Right.
Dr. Vincent Pedre: So maybe I was eating lunch at school, but always, most of the time, maybe we went out once a week to eat. Now people are eating out all the time and they have work dinners. So I think there’s been a drift in the way we lead our lives, and I think that’s really part of the reason, along with the onslaught of chemicals that have been introduced into the environment. When the Environmental Working Group look at the placenta, I think they found 196 different environmental toxins in the placentas that they tested. And these things also affect the gut.
Dr. Kara Fitzgerald: That’s great. Yeah, I think you really covered it. Nice survey of where we are. And it’s like the frog and the pot analogy, it’s little by little, the heat is turned up. Little by little we wholesale moved into the culture we exist now where we’re addicted to our cell phones and so forth. I remember when I got my first smartphone, and then I want to dive into your book, start talking about the solution, actually. But I remember getting my first-
Dr. Vincent Pedre: This is actually a really important part of it because I think when we talk about the gut, a lot of people, first thing they’re thinking is, okay, do I take a probiotic and what do I eat? And they forget that stress also is a really important component and the effect of stress.
Dr. Kara Fitzgerald: Well, and just to your point, the cultural shift to where we are today versus what you described in your childhood, which is reflective of my childhood as well, but I just wanted to say, it’s such a telling and crazy story. I remember standing in line at Starbucks when I had my first smartphone, and there I was in the line in my patient charts, I could access my patient charts. I was finishing a expletive chart in the line at Starbucks, and I was thinking, wow, this is incredibly efficient. This was game changing, and I just thought it was extraordinary. Little did I know that many years later what it would do to my brain. And now having to just absolutely wholesale move away from that, it was incredible. So I imprinted on that moment, that little aha of, oh my God, I’ve just become the most extraordinarily productive human in the world.
Dr. Vincent Pedre: I resisted that for so long. I forget the brand because they don’t exist anymore. I had this phone that had the keyboard on it, so you actually could press the keys, but I couldn’t check my email on the phone. I couldn’t really go to a lot of websites. And I actually liked it that way because I thought, I’m only going to check email when I’m checking email when I’m down at my desk doing that, I don’t want to work while I’m in transit. And I resisted for the longest time not getting an iPhone until the brand I had said, we’re done. We’re not going to make any more of these. And then I had to was like, okay, the next thing is a smartphone, and then of course it’s a dopamine hit, you’re addicted. Because then I could answer an email while I’m standing in line in Starbucks, and I thought, wow, now I don’t have to sit at my desk and do this.
Dr. Kara Fitzgerald: Yep, yep, yep.
Dr. Vincent Pedre: I just made myself more work efficient. But actually you’re adding to your over-activation. I mean, that’s a whole other thing, over-exposure to blue light and what it does to the brain and what it does to sleep and how that messes your sleep up. And you’re never allowing your nervous system to re-regulate itself. You’re always amped up.
Dr. Kara Fitzgerald: And who knew? I mean, it was very insidious. I was like, wow, I’m actually a more productive human right now.
Dr. Vincent Pedre: You’ve got to watch that documentary, the Social Experiment or something like that where it’s insidious, but it was also very deliberate. They knew what they were doing.
Dr. Kara Fitzgerald: Yeah, no doubt. No doubt. No doubt.
Dr. Vincent Pedre: And they know how to stimulate the brain in that way. And I know we’re not here to talk about that. We’re here to talk about how the gut affects the brain.
Dr. Kara Fitzgerald: Let’s talk about that. Listen, you’ve been thinking for many, many moons about the optimal diet for gut health. And so you’ve given us the nice little intro on probably what not to be doing. So what is it? What is the diet that we’re supposed to be prescribing these days?
Dr. Vincent Pedre: I’ve been really evolving over time and thinking about this. And of course, when I speak about diet, I’m putting on my microbiome lenses. So I’m looking at the body through the point of view of the microbiome and thinking how the foods we eat are metabolized by the microbiome. And through those metabolites, which are things like exopolysaccharides, bioactive peptides, short chain fatty acids, how those are either benefiting us or hurting us. And just from recent studies that have come out, there was a great study from Stanford University that decided to look at a high fiber diet versus a high fermented foods diet. It was a small group, it was 18 people per arm, mostly women, I think it was 73% women. And it was a varied age group. And interestingly, they either had them eat a high fiber diet, which was about six to eight servings of fiber per day, or they had them increase their fermented food intake. So high fermented foods, and we’re talking a lot, four to six servings per day.
Dr. Kara Fitzgerald: Wow.
Dr. Vincent Pedre: One serving is a cup, 200 MLs.
Dr. Kara Fitzgerald: Wow. In that study, a serving was a cup? Four to six cups of fermented foods. That’s incredible.
Dr. Vincent Pedre: So a lot of it was actually being accomplished through fermented vegetable brine for your drinking. So it’s much easier to ingest that much ferment. And of course, they didn’t increase them immediately. So they did a four-week ramp up to the desired gold diet, and then six weeks on this high fiber or high fermented foods diet. And then they gave them another seven weeks to basically follow the diet in whatever way they wanted to follow it. And they checked the microbiome along the way, and they did microbiome analysis looking at microbial diversity. So they wanted to see what affects microbial diversity, high fiber versus high fermented foods. Now, if I was the RB, looking at the design of this study, I would’ve probably said, we need a third arm. We need a control group that’s not on a high fiber, not on a high fermented foods diet, to give us a little more comparison.
Dr. Kara Fitzgerald: What was the fiber? Was it a variety or was it a single fiber?
Dr. Vincent Pedre: It was a variety. So increasing things like onions, leeks, blueberries, bananas, so all different sources of fiber.
Dr. Kara Fitzgerald: Okay, okay.
Dr. Vincent Pedre: Yeah. And interestingly, because when I started reading the study, I was thinking, wow, eat the rainbow, the fiber, it’s all these prebiotics. It’s feeding the gut microbiome. It’s got to be the one that wins. I was like at the Kentucky Derby thinking, who’s going to win this race? The other cool thing they looked at is they wanted to look at how does it affect the immune system? So they looked at 19 different inflammatory markers. So they were looking at things like C-reactive protein, but they were also looking at cytokine activation of macrophages and white blood cells. So they were looking at a lot of different ways that the immune system might get activated. And you already probably imagine what the result is, because I-
Dr. Kara Fitzgerald: You’re leading us. Yeah. So tell us, I’m dying to know.
Dr. Vincent Pedre: The fermented foods group had the greatest increase in microbial diversity. And as a result, 19 of their inflammatory markers, all 19 markers dropped.
Dr. Kara Fitzgerald: Interesting.
Dr. Vincent Pedre: So immune activation dropped.
Dr. Kara Fitzgerald: So they had background inflammation. Were these healthy people at the start?
Dr. Vincent Pedre: These were just normal people.
Dr. Kara Fitzgerald: With some background inflammation, like everybody in this world.
Dr. Vincent Pedre: Everyone in this world who’s eating a disordered diet. The people before they started the program, they were eating about 10 to 12 grams of fiber per day, some were a little bit higher at 20. But during the diet, they increased that intake at the highest to around 40 grams.
Dr. Kara Fitzgerald: In the fiber arms?
Dr. Vincent Pedre: In the high fiber group, the fermented foods group was eating about 0.4 cups of fermented foods before. And during the diet they increased at the four to six servings. Some of them got as high as six servings per day.
Dr. Kara Fitzgerald: And it was always that nutritive broth, it was always that prevented broth?
Dr. Vincent Pedre: No, it was yogurt. So the majority of them was either vegetable brine and combined with yogurt, but they could have other things like sauerkraut, kefer. But most of them seemed to gravitate towards yogurt and the vegetable brine drinks. But they did something interesting because they found that the fiber-rich group did have an effect. It was an immunomodulatory effect. And they found that the fiber either increased immune activation or lowered immune activation. So they decided to look at the fiber-rich group and say, well, let’s look at their baseline microbial diversity before they started the program. And they were able to divide the fiber rich group into three levels. So low, moderate, and high microbial diversity before they started the diet.
And not surprisingly, the group with the highest microbial diversity, when you introduce fiber, what they found was that it actually lowered immune activation a bit. And the one with the lowest microbial diversity, when you added fiber, it actually increased immune activation. So there was something there about microbial diversity. And I think this is a really important study to reference when you’re asking me what is the best diet for gut health, because I honestly don’t think that it’s fiber versus ferments. I think it’s both.
Dr. Kara Fitzgerald: I agree with you. I just want to circle back to the finding that the immune system was actually stimulated in those with the lowest fiber at baseline.
Dr. Vincent Pedre: Lowest microbial diversity.
Dr. Kara Fitzgerald: Oh, lowest microbial diversity at baseline, they introduced the fiber. So diversity is obviously going to be stimulated in that context, and they turned the immune system on. Did they infer that this was beneficial or were they looking at this as inflammation? I mean, was there a regulatory process happening?
Dr. Vincent Pedre: They looked at it as it being more of a regulatory process. And the other comment that they had was that they also felt that potentially, had the study been longer, they might have seen that the fiber-rich group also started to have an impact on microbial diversity. But they felt that maybe the study wasn’t long enough, especially the intervention part to come to that conclusion. Maybe had it been two months, three months long, they would’ve started seeing, sorry, longer than because it was already 10 weeks. So longer than that, maybe they would’ve seen changes in microbial diversity.
Dr. Kara Fitzgerald: That makes sense. That makes sense. Because in the ferment group, they’re consuming billions and billions of species.
Dr. Vincent Pedre: And actually we can tie this into the Hadza, the hunter-gatherers in Tanzania.
Dr. Kara Fitzgerald: Yeah.
Dr. Vincent Pedre: Because their gut microbiome is super fascinating. And the cool thing is that they still live in a region of the world where they’re living like our paleolithic ancestors. And I think this is a crazy fact, but for 95% of human evolution, we’ve been hunter-gatherers. So domesticating animals, growing agriculture, all of that, is just the last small snippet of our evolutionary history, which goes way further back. And so an interesting thing as we see in other studies that the types of foods that you eat shape your microbiome. And their microbiome is quite different because they actually have Treponemas in their microbiome.
And we think of Treponema as bad. Treponema pallidum causes syphilis, causes all sorts of neurological issues. Somehow in them, they’re able to keep it immunologically checked. But the Treponema serves a very important purpose because it’s able to digest xylan and cellulose in plant material. And their diets are super high in plant tubers, especially the women. So interestingly, they did a study where they looked at 27 Hadza’s, their stool, aging anywhere from eight to 70 years old. And then they had an Italian cohort that they used as a control, the western control. So you can imagine Italians eating Mediterranean diet, pasta, tomatoes, basil, so legumes, so a varied diet, one of the healthiest diets on the planet. And they compared their gut microbiomes to each other. And it was really interesting because they also did metabolomic analysis. So they were looking at what types of short chain fatty acids were being produced.
And you would guess just like in the west, the predominant short-chain fatty acid for the Italians was butyrate. But for the Hadza it wasn’t, it was propionate.
Dr. Kara Fitzgerald: Interesting.
Dr. Vincent Pedre: And you got to wonder, okay, why is this happening? Well, turns out that propionate is used by the liver for gluconeogenesis, so it becomes an energy source for the body. And the Hadza are hunter-gatherers so there’re going to be periods where they have to fast, where food is not available. So they postulate that maybe this is part of their adaptation. The other interesting thing is and this is from another study, so I’m going to tie this back to stress because I want to mention something about the Hadza. I mean, they are remarkable people. They’re living out in the bush. It’s semi-arid, it’s not the friendliest of conditions, and they’re out in nature, they’re getting rained on.
They are happy, joking, we couldn’t understand the language, but we had such an amazing time through using hand signals and sounds and things like listening to the chiefs speak around the fire pit about lions. And he would talk about an elephant. And you knew what he was talking about, although you had no idea what he was saying. And he was teaching us the names of the different animals. And through the translator, we asked him if they have a word for depression and they didn’t understand. And we kept asking and they’re like, no, no, it doesn’t compute. They have no word for depression in their language. Now how does this tie into the high propionate? Well, there was a study that showed that high propionate is associated with alterations in the gut brain access that increase stress resilience.
Dr. Kara Fitzgerald: That’s fascinating. That’s so fascinating. I think that there was an animal study that suggested high propionate was associated with autistic-like behaviors. And there was sort of a vilification on that study.
Dr. Vincent Pedre: I know that propionate, when I encountered this, I remember that-
Dr. Kara Fitzgerald: It got a lot of press in our world.
Dr. Vincent Pedre: High propionate was vilified because thinking that it’s associated with autism. And then I saw this study and saw, wait a second, it was again one of those moments where I’m reading it and thinking, okay, they’re just going to have really high butyrate because we learn how great butyrate is. It’s anti-inflammatory. It does all these things. And no, they didn’t have high butyrate. And the other thing that was really strange is they had no Bifidobacteria in their gut.
Dr. Kara Fitzgerald: Wow. Fascinating.
Dr. Vincent Pedre: And the only thing that they did, and the researchers commented that they said one thing to do would be to go back and test the stool of infants.
Dr. Kara Fitzgerald: When we have the most Bifido.
Dr. Vincent Pedre: Because they think that what happens. And then they looked at across other rural populations, and it seems like if they’re not having dairy products, that Bifido disappears. Whereas of course in the Italian control, Bifido was there and Bifido is one of the butyrate producers along with Clostridia species. So it becomes very important for us, but apparently not for them. They have a completely different… And the other thing that I think really is very telling about the gut microbiome is that they’re one of the few groups where the microbiome is slightly different between men and women.
And the reason for it is the women stay in camp while the men, they’re the ones who go out foraging, hunting, getting wild honey. And even though there’s a cross between their diet, ultimately the women end up eating more tubers, a much higher fiber diet. And the men probably eat a little more animal product, in general they eat about 70% plants, 30% animals. But they were postulating that because of this, because interestingly the women’s gut had more Treponema than the men’s. And the Treponema help break down all those really difficult to digest plant fibers.
Dr. Kara Fitzgerald: Wow. Well listen, I have two questions. One, I’m curious how you ended up there just, but give me like a snapshot. Because we’ve got a lot to cover.
Dr. Vincent Pedre: Oh my goodness.
Dr. Kara Fitzgerald: But wait, I’m going to ask you question two and then you can answer both.
Dr. Vincent Pedre: Yeah.
Dr. Kara Fitzgerald: What did you take from your experience there that has informed what you’re talking to us about today? So what are you bringing back to us from that experience?
Dr. Vincent Pedre: And I will mention that this was one of the experiences that shaped this book. And I actually talk about the Hadza and my experience there in one of the chapters in the book. You know what? It was a connection through a group that I went to Burning Man with.
Dr. Kara Fitzgerald: Oh, cool. Okay.
Dr. Vincent Pedre: That I was on a WhatsApp chat thread, and one of the guys who, his brand is called Wild Fit, Eric Edmeades, or I don’t know how to say his last name, it’s a Greek last name. He put out an invitation saying he’s taking a group of people to go to Africa and to go hang out with the Hadza. And I had just heard a whole lecture on the Hadza. And I had looked at these research studies about their gut, and I immediately raised my hand.
Dr. Kara Fitzgerald: Like a meant to be moment. Wow.
Dr. Vincent Pedre: Take me. I want to go. And it was incredible. We spent three days, two nights. I mean, I was scared because we were camping out in the wilderness and they actually put a guard out for us and had a fire going all night. But we were in a part of the-
Dr. Kara Fitzgerald: Why was the guard and the fire required?
Dr. Vincent Pedre: I mean, there could be hyenas and it would be rare, there could be a lion or lioness, but that would be a little more rare because they weren’t in that territory. But they were more in an area where hyenas could come through. And it was a little bit scary, but we were all sleeping under this big tree, and it’s a group of probably 15 or 17 of us total. And of course when you’re with people, you feel like protection in numbers, but you’re still a little bit freaked out because you’re in the middle of the wilderness. But it was an amazing experience. I got to go hunting and foraging with them, ate a tuber right out of the ground, had honey, not just honey, but the honey comb, the tiny little non-stinging honeybees in Africa, they looked like tiny flies.
They just poured it in my hands. And I was like, okay, I can’t be rude, I have to just have this just like everybody else. I mean, look, it creates an incredibly diverse gut microbiome. And I think there’s a lot of things to learn from the Hadza. And part of what I took from there, and I sat with the chief and through the translator asked him, what do you do if you get a pneumonia? Or if you guys get sick. And they have all these herbal remedies that have been passed down. And he was very secretive about it. And he is like, we don’t reveal what they are, but they have herbs that they pull and they don’t take antibiotics. So they haven’t been exposed to antibiotics, they’re not exposed to hand sanitizers, antibacterial soaps, they don’t have that concept. They’re out in the wilderness.
So their gut microbiome from a diet that is basically meat, berries, honey, baobab fruit and whatever they can forage, it’s not a very color varied diet. It’s not a rainbow diet. So I really started thinking about it, but it’s a very high fiber diet. They’re having 40 to 50 grams of fiber, just like they did in that intervention group where they got them up to around 40 grams of fiber per day. But I think it’s not just that. I think it’s that they’re out in the wild. They’re getting exposed to nature, they’re getting exposed to the microbiome in the soil. They’re touching. Some of that gets into them. And I think that it’s augments, their microbial diversity. And also if you think about it, they’re a window into the ancestral gut microbiome of what might have existed in Paleolithic times.
Dr. Kara Fitzgerald: Yeah, yeah.
Dr. Vincent Pedre: And I think what’s important, what’s really important, okay, why are we so fascinated with them?
Dr. Kara Fitzgerald: And how did it create the GutSMART Protocol? How does your experience with the Hadza inform where you want to go?
Dr. Vincent Pedre: Well, I just want to quickly diverge and say why all this fascination with this? So first I said microbial diversity is the holy grail. Microbial diversity decreases inflammation, decreases the risk for all sorts of chronic degenerative diseases, including mental illness, like depression. They have no heart disease, they have no diabetes, they have no obesity, they have no cancer.
Dr. Kara Fitzgerald: And they have no depression. They don’t even have a word for depression.
Dr. Vincent Pedre: They don’t have depression. So I think that’s part of the significance of the Hadza. It’s not like we’re going to go and become hunter-gatherers. But part of what I tell people in my book is what we need to take from this is that do whatever you can to get outside into nature. If you have a yard, make your own garden. Bring in organic soil, get your hands dirty, grow your own vegetables because we need that exposure to the natural world, to dirt, to magnify and diversify our own gut microbiome.
Dr. Kara Fitzgerald: And that’s been studied. There’s this region where Russia and Finland meet. I don’t want to misstate the region. I think it’s Karelia, and my apologies, I’m probably not quite saying that. The Finnish side is completely developed. So their agriculture, it’s developed, it’s modern agriculture, things are chopped down, there’s no more forest, et cetera. And they’re using pesticides, et cetera. And then on the Russia side, they’re using old farming techniques, the forest is vibrant. Agribusiness hasn’t descended. They’re not using modern, and they’re just really intimate with the forest and with the plants, with nature.
Allergic disease is rampant in the Finland side, just classic all of the stuff that we see here. And it’s nonexistent in the Russian side. And they look at the skin microbiome. And then they studied the plant, to your point, the plant’s microbiome, they studied the microbiome and the environment, and they see this radical difference between the two. Obviously over in the modernized side, it’s really damaged and diversity has contracted. And we see the commensurate diseases of chronic, of the modern era rising with that. And they don’t see it in Russia, so to your point.
Dr. Vincent Pedre: The same thing that you see that happens to the gut with antibiotics, which is another takeaway from the Hadza, especially, you can’t go back and erase the past. But if you’re a parent or if you’re a parent to be sometime in the future, you can make different choices for your child and try to keep them away from antibiotics as much as possible. My son, who’s 18 years old, has only been on two rounds of antibiotics his entire life. That’s it. And that’s as a parent, as a doctor, who I was willing to take the risk because we could observe him that most times he was sick, it was a viral infection. And the one time he was seven or eight years old and he had an ear infection that just was not budging. And we ended up having to put him on antibiotics.
And he responded immediately. But I think it’s important to try to limit your exposure to antibiotics until only if they’re absolutely necessary and to equate that to what’s happening to the soil. I said, glyphosate, pesticides are like antimicrobials. The same thing that is happening to our gut microbiome is happening to the microbiome of the soil because of the use of glyphosate. And they’ve looked at the shifts in the microbiome of the soil, on soil with crops that are genetically modified that get sprayed with glyphosate because they’re glyphosate resistant crop. And they find that the soil microbiome starts to shift into some harmful types of bacteria that are not good for the soil. The soil loses its microbial diversity.
And then we’re supposed to eat those plants that are growing on this less diverse soil that have less nutrients and minerals because you’re spraying them with a mineral chelator to kill the weeds, but it’s also starving the very plants that we’re supposed to eat of the minerals. So another big lesson is just seeing that we’re not in isolation. What’s happening here to your body is partly because of what’s happening out there. And because of that, I think for the choice of our health, for our patients, we’ve got to encourage them to buy organic as much as possible. Shop at local farmer’s markets, like buy local and try to reduce your exposure to these harmful substances. But also because organic food has more antioxidants, it has higher polyphenol counts, it’s just going to be better for you.
Dr. Kara Fitzgerald: But organic, like agribusiness organic is not as robust as local?
Dr. Vincent Pedre: Not as robust. And I can tell you, I see the difference when I would go to my organic farmer in my old neighborhood, and I still will go back there from time to time, they’re an organic farm. They’re from Egypt, and her husband is an engineer. And he decided to go back and study the ancient agricultural ways that were being used back in the time of the Egyptian culture.
Dr. Kara Fitzgerald: The Pharaohs.
Dr. Vincent Pedre: The Pharaohs with the Nile. And it’s basically an organic technique, and they apply it to the way that they grow their food. But they also, I know this might get it a little bit woo-woo, but they also pray over their vegetables. They pray over their plants. Kara, the produce that I get from them will stay fresh in my refrigerator four to five times longer than anything that I buy mass-produced organic.
Dr. Kara Fitzgerald: That’s fascinating. Are you in the city?
Dr. Vincent Pedre: Yeah. I’m in New York City.
Dr. Kara Fitzgerald: So they have a farm in the city?
Dr. Vincent Pedre: No, their farm is in pretty far upstate New York. Okay. Yeah. It’s called Norwalk Farm. Yeah.
Dr. Kara Fitzgerald: And then they bring stuff in and they sell it?
Dr. Vincent Pedre: They drive in. It takes them four hours to get here. It’s just amazing. And the other thing is when you go to the farmer’s market and you meet the farmer and you get so much closer to where your food comes from, I think there’s such a greater level of appreciation for what it takes.
Dr. Kara Fitzgerald: Awesome. I love it. What’s the name of this farm again?
Dr. Vincent Pedre: Actually, they’re called Norwalk Farm. And they’ve actually been written up in the New York Times because a lot of the high end restaurants in New York City will buy produce from them because they have very rare varietals, heirloom varietals that cannot be found anywhere else that they’ve preserved.
Dr. Kara Fitzgerald: That’s pretty cool. That’s really interesting. Listen, this is a little bit of a left field question. What do you think of Himalayan tartary buckwheat? Our mentor, Dr. Jeff Bland, of course, is growing it and I think the first farms are in upstate New York, which is what made me think of it. But I think it’s a little bit of a badass nutrient that I find interesting. And have you given it any thought? Is it on your radar at all, Himalayan tartary buckwheat?
Dr. Vincent Pedre: It’s like peripherally. I mean, if it’s buckwheat, so it’s gluten-free.
Dr. Kara Fitzgerald: The thing that’s interesting about it, and maybe you’ll check it out, and I have more questions for you, so I don’t want to digress here too much, is that it grows in the Himalaya and it grows in such difficult environments that it’s busting at the seam with those sophisticated polyphenol, phytochemicals beyond just polyphenols. It’s just loaded up with these chemicals.
Dr. Vincent Pedre: So it’s almost like what you said is that it’s a hormetic stressor_
Dr. Kara Fitzgerald: Yes.
Dr. Vincent Pedre: Creates a stronger plant with greater antioxidants. And even though I don’t talk about this, but I do talk about hormetic stress in my book and tie it back to look at the Hadza living out in the environment, but also things that we can do that can improve our stress resilience. But that’s fascinating. Now it’s in my radar. So it’s Himalayan?
Dr. Kara Fitzgerald: Himalayan tartary buckwheat. And I’m personally bullish on it just because of the quantity. And they’ve quantified, there’s such a huge variety of phytochemicals in it and of robust amounts, of therapeutic amounts. And you can buy it as a flour and you can make pancakes, or you can take it in capsules and get a therapeutic amount in a few caps because it’s so ridiculously potent. So it fits, it’s certainly in alignment with your book.
Dr. Vincent Pedre: And I love these non-gluten grains that we can introduce into our diets, because even though wheat is contaminated with glyphosate, and we’ve got to be really careful with that.
Dr. Kara Fitzgerald: Yeah. And they’re really mindful around how they’re growing it. But I know that it started in New York state, and I think that it’s still just only grown in just a few areas in upstate New York. I’m keep going this way because New York is that way. I’m right next door.
Dr. Vincent Pedre: New York is in there.
Dr. Kara Fitzgerald: Okay. So I want to say that I love just the breadth and the energy around how you’ve taken The GutSMART Protocol, just this very holistic approach, it’s extremely broad. And so I do want to get to brass tacks, like how much fiber should we be eating? What should we be eating? How much fermented foods should we be eating? Should we be going for four to six cups as they did in this study? I want to get that, but I just want you to give me the overview of what your protocol looks like. And beyond the diet, how do we build resilience? How do we become a little bit like the Hadza here in the states?
Dr. Vincent Pedre: There’s so many golden nuggets for people in my book for building resilience in different ways. But the pivot point of the program is taking the GutSMART quiz, finding out what your GutSMART score is. You get a number score, but you also get a qualitative score. The number score is from 25 to 450. The qualitative will be mild, moderate, or severe. And that basically breaks you down into categories. And why is that important? It’s important because if you’re in a severe category, you can’t eat the same as someone who has mild gut issues. And this is what I wanted, this was a really big challenge, Kara, to basically figure out how in one book can I help all the variety of people that I’ve noticed and seen through my 10 plus years of really diving into gut health and seeing so many gut patients and realizing that you can’t just say one diet for all. If someone classifies as severe, they have leaky gut, no question. They’ve got a lot of gut dysbiosis, and they can have fermented foods.
And they might also have trouble eating raw vegetables. They might have to stick with cooked veggies only. And certain types of veggies that are not going to irritate the gut so much. So people go through the protocol and follow it. And there’s so many layers to it, like learning how to be intuitive about your eating, listening to your body. Because the other thing is, and I know you preach this also, that ultimately the healer is you. And as much as we can provide guidance, and I went through extremes, consulted with clinical nutritionist, consulted with fermentationists to really dial down what should be in each category and how should we treat this. But even then, something might be wrong for a person. They’ve got to develop that inner intuition. But another really important piece of this is developing that stress, resilience, that inner strength.
And it all comes down, in my opinion, it has to do with the vagus nerve. And we started at the very beginning talking about stress and the effects on the body. And why has gut issues become so much worse? Well, another player is low vagal tone. Low vagal tone is associated with acid reflux, with constipation, with poor digestion, less ability to break down proteins, but it’s also associated with things you wouldn’t think are associated with low vagal tone like migraines, anxiety, depression, all of these things are tied to low vagal tone. So I talk about ways that you can reactivate the vagus nerve. And like you said, the plan is very holistic, it’s not just how you eat, it’s how you live your life. And for that reason, I devoted a whole chapter to talking about the role of the vagus nerve, why it’s so important, how you can activate it using different types of hormetic stressors, even like cold plunging or even just getting cold water on your face and your neck where there are cold receptors that will activate your vagus nerve.
Or using things like humming or even just grabbing the tragus and stimulating it. These are ways that you can reactivate that vagus nerve. And then using breath work and meditation. And one of my favorites actually, when I was writing the book, I had three different meditation teachers that I wanted to contribute and three breath work teachers. And I actually ended up with more. But there was one meditation teacher that kept saying, they’ll get back to me, they’ll get back to me. And finally, I just needed to finish this chapter, and I’m like, I’m not going to wait for you to get back to me.
But I’ve been meditating since I was 21. And I’ve done a lot of different meditations. And one of my favorite meditations is a Tibetan loving kindness meditation. And one big thing that I’ve noticed with people when they have chronic disease, when they have chronic gut issues, is that they start treating their gut as if it’s their enemy, it’s not their friend anymore. They develop an antagonistic relationship with that part of themselves. And so I took that Tibetan loving kindness meditation and turned it into the gut love meditation.
Dr. Kara Fitzgerald: I love it. That’s really great.
Dr. Vincent Pedre: And basically just reteaching people how to reframe that relationship with themselves, which I think is a really important piece of the healing journey, is rewriting that relationship with your sick body, whatever it is, whatever that chronic health issue is, and not letting the chronic health issue or the chronic gut issues or whatever they are, be the defining factor in who you are.
And so you asked, how much fiber should we eat? How much fermented foods should we eat? That makes me think of another study that came out in December, I think it was in nature. And they took about, I think it was about 45 people, and they divided them into two groups. These were healthy people that were just normal living their lives, and they wanted to look at the effect of stress and whether diet influences how stress is perceived in the brain. So they weren’t going to psychotherapy.
So they all did a standardized perceived stress questionnaire. It’s called the Cohen PSS, perceived stress questionnaire. And they divided them into two groups. One with a control group that was just given general dietary guidelines. This was in Ireland, so I guess they have their own dietary pyramid that they told people to eat and less processed foods, whatever. And then another group where they asked them to increase their fiber to six to eight servings per day, grains to five to eight servings per day and ferments two to three servings, not the four to six. That was in the other study. And they found that there was a statistically significant difference in the post-test stress score, and it was only a four-week study, but the intervention group, they dropped their stress score by 32%, whereas the control group, it was 17%.
And the difference was statistically significant enough to say the diet did something. It’s doing something through the modulation of the gut microbiome. Interestingly, they were looking at microbial volatility, which is the change. They were looking at this at this [inaudible 00:53:31] score, like a change in beta diversity over time. And what they found was that if the volatility was really high, stress scores tended to be higher. If the volatility was low, the change in the microbiome was low, stress cores dropped. And they found that in the intervention group, the volatility was lower in the control group, volatility tended to be high.
Dr. Kara Fitzgerald: That’s interesting.
Dr. Vincent Pedre: And so you look at this and you think, wow, diet can modulate the way the brain is functioning. Just tying back to how stress affects the gut. But the gut also affects our stress perception through the gut brain access. And it makes me think that it’s hard for people to eat a lot of ferments. You tell people two to three servings per day. And again, take the GutSMART quiz, figure out if ferments are right for you or not yet. But I think we need to be thinking about them, and we need to be increasing our vegetable intake. And I know you talk about this in your book, Younger You, that we’re not getting enough vegetables. The amount that we need in order to change the microbiome, and then epigenetically change the way our genes are being expressed is much higher than what we’re getting.
And I think what I’m inserting in there is that also, the ferments, they’re like, hey, we’ve been around for 10,000 years. We were first used in China like 7,000 years ago when they were fermenting rice, honey and grains. And we need that. That’s part of what creates this diversity, but also this resilience, this lowering of inflammatory markers that makes people much healthier both physically and mentally.
Dr. Kara Fitzgerald: And this is The GutSMART Protocol. We’re at the end of our podcast, I think this has been such a lovely conversation. I have to say, it’s just such an unexpected, delightful conversation. I want to give you an opportunity to just touch on anything you feel like you need to touch on. But the way that you’ve taken, really, this is like system medicine, psychic medicine. Of course it’s the solution to this gut epidemic that we’re in, just unraveling and taking us back to where we were. And I like how broad and inclusive the quiz is because we have patients, of course, walking through our doors who have been eating four foods for the last month, that’s all they can tolerate or maybe even longer. And they’re malnourished and they’re afraid of food, and their gut is the enemy. There is this volatile relationship. The fact that you’ve brought up loving kindness meditation to gut is just like a stroke of utter brilliance because that patient coming through our door is in war with themselves.
Dr. Vincent Pedre: You can’t heal a body that you don’t love.
Dr. Kara Fitzgerald: Yeah. So it’s step by step. The fact that your protocol really acknowledges that and there’s no force, you’re not forcing, I mean, you’ll lose folks if you’re insisting that this one defined diet is the correct diet. There’s a journey towards restoring. I get that. So I appreciate that factor.
Dr. Vincent Pedre: I think we can learn a lot by seeing… There’s so many examples. I’m so curious about the blue zones, and we didn’t get into this, but I’ve been curious about the gut microbiome as we age, and what’s different about the gut microbiome of centenarians versus people who don’t live to become a hundred.
Dr. Kara Fitzgerald: Well, we know diversity is a piece, certainly.
Dr. Vincent Pedre: Diversity is a piece. And one other part of it is I’m going to say stress resilience, the ability of their microbiome to lower inflammation, whereas others who don’t live as long, their microbiome loses the ability as we age. A lot of people, their microbiome ages in a way that it loses the ability to control inflammation in the body. Whereas you look at these centenarians and their microbiome still has the ability to bring down inflammation.
Dr. Kara Fitzgerald: Oh, interesting. I mean, I knew diversity was a piece, and then you would extend on that and assume that they’re influencing obviously some of the breakdown. But yeah, that’s fascinating that that’s been evaluated. What else? Is there anything that you would like to leave us with? I know that we could probably talk for another two hours.
Dr. Vincent Pedre: God, I feel like we’ve had such a great conversation and I’m so appreciative of being able to share these musings that I have. I haven’t stopped looking at the literature since I turned in my manuscript because stuff just keeps coming out. There was a study in December that showed that 13 different bacterial taxa are associated with depression. And one avenue to depression is the production of TMA from a bacteria called Hungatella that then gets converted to TMAO, which we know increases stroke and heart disease risk. But I didn’t know that TMAO also increases risk of depression.
Dr. Kara Fitzgerald: Yeah, that’s interesting.
Dr. Vincent Pedre: I did not know that. So I mean, God, I just can’t wait for people to read this book. And I think you captured a lot of pieces of it that it’s really a holistic mind body, gut plan.
Dr. Kara Fitzgerald: I want to show one other thing that you sent me that I just really can’t wait to use. It’s a fermentation kit.
Dr. Vincent Pedre: Oh my gosh, yes. Yes.
Dr. Kara Fitzgerald: I can’t wait to bust this out.
Dr. Vincent Pedre: That was such a nice gift from Chouami that creates these fermentation kits that has the spring mechanism so it can let the gas go out. Super excited about that. I really appreciate being on your podcast and sharing this information. I think that it can be so empowering to people.
Dr. Kara Fitzgerald: We need answers. We’re in a challenging time and I think that-
Dr. Vincent Pedre: We’ve got to reverse the train because we are on a train that’s heading towards a cliff.
Dr. Kara Fitzgerald: Perhaps it’s already midway.
Dr. Vincent Pedre: It’s already like midway. We’ve got to pull the brakes and then hit the reverse engines because it’s not pretty where society is going.
Dr. Kara Fitzgerald: Yeah. I think that you’ve given us some tools though, to begin to unwind it and it’s not another course of xifaxan, it’s a lot more.
Dr. Vincent Pedre: No.
Dr. Kara Fitzgerald: All right. Dr. Pedre, thank you loads and loads and loads for coming on the show, and I wish you the best of luck in your book. We’ll certainly be supporting GutSMART Protocol, not in this podcast obviously, but just more broadly in our social media. It’s a really good work that you’ve done. It’s really inspiring.
Dr. Vincent Pedre: Thank you. I really appreciate it.
Dr. Kara Fitzgerald: As always, thank you for listening to New Frontiers in Functional Medicine, where our sponsors help bring the very best minds in functional medicine, and today is no exception. Not everyone can be a sponsor on my platform, and I so appreciate the good work, relentless research, and generous support from my friends at Rupa Health, Biotics and Integrative Therapeutics. These are brands I know and trust in my own clinic and can confidently recommend to you. Visit them at RupaHealth.com, BioticsResearch.com and IntregrativePro.com, and please, tell them you learned about them on New Frontiers.
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Dr. Vincent Pedre is the Medical Director of Pedre Integrative Health and Founder of Dr. Pedre Wellness, CEO/Founder of Happy Gut Life LLC, has worked as a nutraceutical consultant and spokesperson for NatureMD, and is a Functional Medicine-Certified Practitioner with a concierge practice in New York City since 2004. He believes the gut is the gateway to excellent wellness. His newest book, The GutSMART Protocol — featuring a 14-day personalized gut-healing plan based on the GutSMART Quiz — is the culmination of years of research and clinical experience as a functional gut health expert.