S8E8: Tummy Trouble: Breaking Down the Complexities of the Digestive System (Part 1)

Welcome to Coffee with Dr. Stewart. This show will provide our listeners up-to-date medical information from a leading neurologist and neuroimmune specialist. Your host is Courtney Stewart and your medical expert is Dr. Kendall Stewart. So grab your favorite beverage, we're cup of coffee, and let's have coffee with Dr. Stewart. Hello everybody and welcome back to another episode of Coffee with Dr. Stewart. I'm your host Courtney Stewart and today we're going to be bringing you an episode on tummy trouble. But first I got to ask Dr. Stewart, dad, how are you doing today? I'm good. I'm very good today. That's good to hear. Are you ready? Sure. I'm always ready. All right. The talk? Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah. All right. Well let's dive in. So we chose tummy trouble because everybody in their life has faced some sort of stomach pain. Sometimes it's weekly. Sometimes it's rarely. Sometimes it's chronically. And so we really want to break down how complex the digestive system is, I think it's something that a lot of people overlook. And so to start us off, I have a little story. Hmm. Okay. You ready for my story? You're going to know the story. Oh, I do. Okay. Let's hear it again. All right. So my anatomy and physiology professor was telling us a story about a patient he had and her husband was a super doctor. And so he had two main specialties. And so one of his specialties was Crohn's. And so my professor had been on a lot of medical mission trips. And he was saying that, you know, overseas you rarely see people with stomach disorders, like Crohn's and CBO and IBS and things like that. And so he asked his patient, what does your husband think about why people don't have these disorders over his teeth? And he said, it's because they don't eat enough dirt. Well. You think about that should you have it? Well, probably not necessarily itself. I know there's a TikTok challenge on that, right? Or they actually have people eating dirt. Truthfully. Yeah, I wouldn't necessarily recommend that. But the answer to that is probably yes in an indirect way. Okay. So clearly what we know about the microbiome is throughout the entire development of the human, we have a synergistic relationship with our environment. And those synergistic relationships involves fungus, involve bacteria, involve yeast of certain types. And they actually do a lot of things for us. And I think we're just finally over the last 10 to 15 years starting to wrap our hands around how symbiotic our relationship is with our gut and everything else. So where would most of those bacteria and things come from in the answers dirt? Okay. And so in general, you know, you think about older living, people had gardens, they ate stuff out of the garden. Sometimes you didn't wash it very good. Sometimes you actually ate it straight out of the garden. Yeah. And you didn't even wash it. I've done that. And so a lot of people are really discussing the fact that yes, we probably need those soil bacteria. And some of the other things found in the soil that actually can be very good for us. We probably are being a little bit too hygienic, especially after COVID. It's like ridiculous. Like when they had a spring, your groceries and your vegetables when you came home, that's ridiculous. But in general, I can tell you that yeah, there's some truth to that, but I wouldn't recommend going out with your, you know, your spoon. I'm just, yeah, no mud pies, no mud pies. Well, there is a, there is a syndrome called Pica. And Pica is a syndrome where people do crave dirt and clay and other things like that. And we do believe that some of that's mineral base, but some of it's also probably probiotic or pre-botic or post-botic based, meaning that we have an issue where the body knows it needs something. And that's where you go. We know it happens in a lot of pregnant women. I've heard that. A lot of children. And unfortunately, typically, some people even believe it's in children who weren't vaginally born, were born by C-section or not breastfed and didn't necessarily get the probiotics or the bacterial colonization of the intestinal tract quite right. That's interesting. So they tend to be dirt. Yeah, because I've heard a lot of women like, they crave that because of like heartburn or reflux. Is that true? Well, so the answer is there's all kinds of things. And you got to separate it. So I mean, tummy trouble is, this is a huge, huge topic. And I'm going to tell you, you know, I want to be very clear though that, first of all, I'm not a gastroenterologist. Okay. But I am an immunologist, meaning that I do have a lot of knowledge base in the immune system. And my specialty, you know, is neuro. But you can't separate the intestinal tract from the rest of the immune system. In fact, they are synergistically bonded. And like a lot of people like to say, there's 80% of the immune system surrounds the gut. Now, I used to think very simply that that's because that was the biggest source of, source of contamination in our body because the gut's a dirty place. Well, that's really not the case. It turns out that those immune cells need specific things from those bacteria that are in your gut in order to function properly or to regulate themselves in order to get the proper nutrients. And it is just a ridiculously complicated and beautiful mechanism that good Lord created. Yes. Yeah. I think a lot of people don't realize like I just learned this last week, like the digestive system has its own nervous system, which is like crazy. How complex it is. And so I want to go back to the microbiome of the gut. You mentioned probiotics, prebiotics, postbiotics. Stableotics. Yes. What exactly are they? And why do we need them? All right. So, you know, there's finally, I think there's a consensus now, basically between people who take care of kids versus people who study the microbiome. Prebiotics are basically compounds that typically feed the gut microbiome and are almost always based in fiber. Okay. Now, there can be many, many types of fiber, but these types of fiber have both soluble and insoluble forms of different types of glycoproteins and different types of prefadiacid metabolites that basically are able to feed the environment of the gut to be able to grow proper bacteria. Probiotics are essentially the bacteria that are introduced through the oral cavity into the gut that are beneficial to us. Great. The technique of those is the beneficial bacteria, the beneficial yeast, et cetera, that we actually have in our bowel. And typically postbiotics are really interesting because that's the newest term that came out. Postbiotics is basically a list of the things that those probiotics combined with prebiotics make that are metabolites that assist the bowel. Interesting. So, basically, it's saying, once the probiotic colonizes and get in there, what are they making that is beneficial to the body? And that's what they call postbiotics. Okay. And then there's synbotics. Yes, I heard that one. Yeah, synbotics is really interesting. Symbotics is saying that instead of the bacteria making something, there's actually a synergistic relationship between the body and the organism itself. So, something that's symbiotically working together to provide the benefit. And so, those are really interesting definitions because everybody tends to have heard about prebiotics. Most people have heard of probiotics very easily. They don't think of postbiotics. And the reason we'll talk about postbiotics is because if you have trouble growing probiotics in your bowel, we need to put the postbiotics into you so that you still get the benefit of the immune system and all the other vitamins that the bacteria make. Yes. This is a big thing about eating culture foods and fermented foods. So, what role does that play in that? Wow, that's a big question too. Because it's not just those cultured foods and fermented foods having those bacteria in them. But they also have, so culture foods are prebiotics plus probiotics together. But then they're also postbiotics in there too because cultured foods are known to give us butyric acid or known to give us propionic acid and some of their metabolites which have all kinds of beautiful effects on the gut. Propionic acid seals the gut lining to make it more protective. Propionic acid is an anti-inflammatory butyric acid which we have to make in the gut because if you've ever tried to make a supplement out of it, it stinks to high health. Soil for. And so eating foods that contain those which have, which is able to cover a lot of that smell and stuff, you get them in the quantities that you really need it. Okay. And then like I know genetically you can tell if somebody can't make certain, can't make them, can't protect them, can't grow them. Okay. So the bowel wants those bacteria to grow. And so it turns out that we have designated people as secreters, non-secreters or moderate secreters and that basically has to do with what's called fucosal sugars. So there is a enzyme call fucosal trans. for ACE 2 is the one that we typically follow. And that tells us how well you make these special fucosal sugars that are secreted into the bowel to grow them. So basically the concept is I like to think about you got these seeds and it's kind of biblical because they do speak of this in the Bible. But if you throw those seeds out, they're going to land in different places, right? Biblically. But also in the bowel, if we have great sugars and great soil, they'll take hold and they grow great. But it turns out if some people don't secrete those sugars, you can throw it out and it's like throwing seeds on concrete. They might sprout, but they're never going to take hold and colonize the bowel. So it becomes very difficult. And then it even becomes even more difficult because if you don't colonize good bacteria there, there tends to be something that comes along that's bad that can actually do its job at sticking there. And when that happens, we really get ourselves into trouble. And talking about sticky things, there's also biofilms that are all around. I think a lot of times we just think of it as biofilm on our teeth or an IV catheter. But you think of that. That's what I think about. And Michael's grow. I was growing up. I was growing up. We didn't even talk about biofilms. Okay. We didn't think about them. But basically it, well, let's talk about it. So if the gut, the gut has a mucus, a mucus layer too. So the gut really in healthy situations grows a mucus layer. Now it turns out when butyric acid and propionic acid are made by these bacteria, it tells the gut to secrete that mucus. So it's one of those relationships. And that mucus is supposed to coat the interocite or the bowel cells to keep them from being harmed by the environment or any of the negative things. The problem is if that ever gets interrupted, then bacteria have a way to actually stick and really take hold in an area of the gut that is not mucus lined. And that if it gets bad enough can lead to what we call sebo, small intestinal bowel overgrowth. And those bacteria want to stay there as hard as they can. And so they are very clever in some of them that they can actually form a membrane that we call a bowel film that protects anything from coming and getting it. Okay, whether it's a food, whether it's an antibiotic. And if those become big enough, then we get into malabsorption, we get into sneaky poop, we get into irritation and inflammation and all the things that we really don't want. And so the classic thing that people think of biofilms is somebody who really comes in and has chronic diarrhea and stuff like that. I can tell you it's probably a way bigger deal than we think. I like to think of it in terms of sometimes even vitamin deficiencies. If we get a test of the blood count and we find out the red blood cells are big, we typically think of B12 deficiency. And the problem is that we feed them B12 and a lot of those people that doesn't get any better. So what we've actually found out is B12 has to be manufactured by bacteria, either in foods that you eat or by bacteria in your bowel. But if there's a biofilm there, there's no way that not only can the gut not make intrinsic factor, which is something that has to grab the B12, but the B12 can't get to the cell because there's a biofilm building there. So it may be as simple as seeing somebody who has large red blood cells that don't respond very well to B12 that they could have a biofilm and we could be missing the whole point. And same with people who bruise easily, vitamin K is another one of those beautiful vitamins made by gut bacteria. And so if we don't have gut bacteria, we can't make vitamin K an absolute. And so we've got to have this nice balance. The problem is the number of bacteria in the bowel physically is enormous. And I'm not talking about the number of different ones. And so we have this way, we have some elegant ways to look at all the organisms in the bowel, but the problem is we still haven't been really great at figuring out which ones are bad and which ones are good. We know the obvious ones. But when you get a report like that, the important part of doing any type of test is knowing what the heck to do with it. And so I can tell you microbiome testing is available. It's not necessarily cheap. It's, I would call it moderately cost, but the problem is you've got to decipher it. And there's also viruses, there's bacteria phases, there's fungi, there's all kinds of things in there. And trying to decipher that is a big challenge for a lot of doctors. Yes. Yes, going back to kind of our dirt topic. Yeah. I know in the US there's a lot of pesticides used and there's also a lot of processed foods. And so how does that affect? Well, you're asking. Yeah, you're asking some tough questions. Well, I mean, I think the easiest way to describe this, you're going to hear a lot about gluten sensitivity. Yes. I'm not talking about celiac disease. Okay. So there's two forms of gluten, gluten issues. One is celiac disease where you literally get a massive inflammatory response to the gluten which is. Yeah, that's the allergy. It stands for a glue. It's a protein that's found in a lot of, a lot of seed products like wheat and rye. The problem is if you develop celiac, then you have to completely avoid those foods because you literally have a massive breakdown in toxicity and inflammatory reaction to those which can be so severe that it alters your organs and anything else. Now that is fairly rare. But gluten sensitivity is becoming more common. Yeah. That's what I got. And what that really means is that if you, the easiest way to tell is if you avoid gluten for a certain period of time and then you go back and we call it avoidance provocation, you avoid it for a certain period of time and then you go back and eat it. And if your stomach starts bothering, you're hurting or cramping or whatever, you probably do have a sensitivity to that food. Now sensitivity is coming to forms. We have immediate hypersensitivity. That's where I put a food in my mouth and my lips swell and it's itching and all that kind. That's easy to tell. There's a delayed sensitivity which is more of a cellular-braised sensitivity which can happen up to several hours after you eat the food. And as complex of foods as we in the U.S., good luck trying to figure out. Now gluten sensitivity seems to be on the rise. Gluten sensitivity seems to be more prevalent in more developed countries. And there's a lot of my patients that are gluten sensitive in the U.S. and then they go to Europe and they say, "Oh, man. I gluten all the time over there and it didn't bother me." And there's even enough recognition of that concept that there's lots of papers on. And there's lots of speculation on why that's going down. Okay. Now that speculation can be based on the wheat products we use in the U.S. versus what they use in Europe. And the U.S., we tend to grow a lot of hard red wheat that has a high gluten concentration. That's because we lack white bread. Okay. Whereas in Europe, they tend to use more sourdough techniques, which most people have started to realize that sourdough. Yeah, in the U.S. big trend to do sourdough. Yeah, which is great. I love it. But the thing is, they also use what's called a soft red wheat in Europe. Mostly it grows better in that climate. It's kind of their traditional things. It's a lower gluten alternative. And so it also has to do with quantities. You know, we don't weed itself. We're not aware that we've geomoded yet, but we have hybridized it. And hybridized means that we're looking for quantity or for quality. Now the third issue, which is probably the biggest issue. And it's an issue we got to be a little careful talking about because we don't want to make a lot of people mad and we don't want to be put a bullseye on her head, but it has to do with like a phosphates. Okay. Glacophosphates are herbicides. We have altered some of our foods where we can spray herbicides on them. We can kill the things we don't want in the field and because we modified the corn or whatever the corn doesn't die from the herbicide. Okay. So that's corn and soybeans and things like that. Now wheat, they have not modified it that we are aware of. But what they do is before they grow the field, they spray the herbicide to kill everything else and then they plant the wheat. And then when the wheat's ready, they want to dry it out so they spray it again so that it dies and dries out quickly before they harvest it. Now the problem with glycophosphates is they are not washed off by water. They stick to the plant. Okay. And so, and with most things that are chemical based, they're not just herbicides, they're also bacteriocytic, which means they actually have the ability to kill bacteria. So you may unwillingly or unknowingly eat this delicious piece of bread that has glycophosphates. a phosphates on it. And you just basically might as well have taken an antibiotic. And everybody tends to know how the bowel works with antibiotics. Now with gluten sensitivity, the more inflammation you create in the bowel, which not only probiotics keep from happening by its metabolites, but you also then expose from the inflammation, the immune system to the wheat. And then we throw in yeast, which is very immune modulating because we like to eat our wheat with our yeast. And next thing, you know, you're sensitive to something that you love. Wow. How sourdough different? Sourdough firmets itself. And so sourdough, in Europe, I know they use less glycophosphates. I know they use it to desiccate the wheat in some forms. And so that's the big question, what's really going on? I can tell you you're probably fighting a big lobby because in farming, quantity is everything. And getting getting even scheduled, I'm sure to harvest your field is a hard deal. So you don't have a lot of time to sit around and just wait for the wheat to kind of naturally desiccate. So they drive the whole thing, you know, by spraying it. And so I, you know, there's a lot of questions. I'm not trying to be ugly to the farmers, but my job is to look at health. Okay, so we've got to look at all aspects of health. And I can tell you the amount of glycophosphates that they are finding in the soil from previous springs is enormous. And so a lot of people are saying, well, they'll grow corn right next to wheat when we spray the corn, what happens to the wheat. And so I mean, there's a lot of discussion here. I think it, I think it really needs to be looked at closely with some unbiased opinions. Now if you're a GI person and a chemical, you know, you don't like chemicals in the environment and everything, you're going to have bias. And if you're a farmer, yeah, that has to use it for the thing. They're going to have bias. So trying to find an unbiased source. It's hard. Very, very difficult. And there's going to be an argument toward everything. I just think that, I mean, the increase in glycophosphates, I mean, I've heard like staggering numbers of how much we we spray glyphosphates on our crops in the United. So I mean, that's a great thing. I can tell you when you get to other countries that are underdeveloped, anything they're growing is probably the seed harvest from last year. Yeah. And doesn't have any type of hybridization or everything. And they're probably growing it naturally. And I'm sure their crops are not as pretty and as yes, you know, fruitful as the ones here in the US. But you know, these are huge questions. Yeah. Whenever we were planning this podcast, I had asked you a question because I thought, or I feel like ulcers or some of ulcers are a common thing we see in the US. But you actually told me that we see less stomach ulcers now. Why is that? Well, so we used to think stomach ulcers were high stress. She made too much gastric acid. And so we came up with these antacids. And then we came up with a new group of medicines, which were histamine blockers. And we came up with another group, which were proton pump inhibitors. And so the idea was, let's decrease the acid and decrease the reflux. Okay. Well, that may have done away because from what I'm told before I became a physician, stomach ulcers were really a problem. In fact, bleeding ulcers and hospitalizations and the stomach were, I'm told, was was really, really common. So those did their job to a certain degree where we've done away with a lot of those bleeding ulcer issues for the most part. Now these are people that don't come to see me, you know. So I'm going to say that's with a little bit of caveat, meaning that my experience is a little limited in that. Now, the problem is we're even realizing we used to be told that the stomach was so acidic, nothing could grow there. Why? Okay. Just like, oh, the Yellowstone geysers are so hot, nothing can grow there. And then you look at the grand prison, prismatic spring and all the different colors or bacteria and organisms growing in it. Well, it turns out the stomach does have certain things that can grow there. And those probiotics that are growing there have benefit for the innate immune system, which is the one your mom gives you. And apparently, they're very important in infants to get the innate immune system working and to keep going. Now, the problem is when we change the pH of the stomach, we change the pH upward, which means it's more alkaline and those bacteria can't grow as well. So it gives them an opportunist that we call H-Pylaury. Okay, which is associated with stomach ulcers and inflammation. And it's what a lot of us doctors test for when we see chronic indigestion. Okay. Okay. And we're taught to kill that with antibiotics. We're taught, most people are, I mean, you can go down and buy all your acid medicines down at the local grocery store or pharmacy right over the counter. But it may be that we actually have overdone a good thing. And we still have stomach ulcers. We have stomach cancer still. We have a softadial cancer. We have gastric reflux, you know, but the whole idea is I think we need to pay a little bit more attention for those being absolutely indicated versus just generally indicated. Everybody should decrease their stomach acid. And so in general, that pH in the stomach does serve a purpose. The problem is if our diet is not so great, a lot of times the acid will become a problem and reflux and high ital churnia's and all the other things you have to deal with. Yeah. Yeah. I answer your question. Yes. Yes, he did. Another big thing that we see is constipation or chronic constipation. And so what are your thoughts on this? And also, oxidives and can oxidives ever become harmful? Wow. Wow. Big another huge topic. And we could probably do podcasts on just those. Chronic constipation is a huge problem in women. Why is that? I think some of it's social. Okay. I mean, I like to think that guys are not as nervous about going to the number two in public as women tend to be and they're conscious of that. You know what I'm saying? But the problem is too is that we know there's probably some inherent difference in the microbiome and women in men. Okay. And I'm sure that you know in your family that when somebody toots dad smells different than moms all the time. I hate to say it like that, but that's really the way it is. And so I don't think that anybody that's been around a family really has any questions that the microbiomes different in males and females. Yeah. Okay. Think about that. All right. Well, I'm just saying. Okay. Now with that being said though, it really is a very complex topic. Chronic constipation really has to do with the inability to peristals or drive fecal matter through the bowel and tip particularly is focused on the colon and the clonic cells. Now that issue everybody's trying to figure out whether what it really causes it. So they really discuss things between motility issues where somebody's bowel just doesn't work the way it's supposed to versus normal motility, but then it's just not working like it should. Yeah. So really complex studies of this will look at motility of the bowel is the bowel capable of generating the peristalsis or the ability to push that. And then based on that, they'll look at agents that naturally or pharmaceuticaly stimulate. Okay. Okay. Now in treatment of constipation, there are all kinds of therapeutics. The therapeutics that are most common are things that concentrate in the bowel and pull water in and basically just create more water in the bowel. Okay. Okay. And does that lead into diarrhea? Sometimes explosive diarrhea if you do it wrong. Or my microbiology professor likes to call it intestinal sneezing. Yeah. So you're yeah. Well, you're talking about you're talking about things like polyethylene, like home. Okay. Okay. You're talking about things that essentially are highly concentrated and water absorbs out of the body into the bowel to essentially make things less more bulky, have more to work at and actually push out easily easier. Okay. The second form that we have is natural things. Okay. And those natural things can include things like peppermint oil, can include things that probiotics that make butyric acid because GABA, the amine of the neurotransmitter that's made from butyric acid is responsible for relaxation of muscles. Okay. And so in peristalsis, it's just as important to relax the muscle it is to squeeze it. We can't push thing through a pipe. It's got to be moving. So the relaxation and the contraction are handled by two different neurotransmitters. Gabata relaxes it acetylcholine typically to contract it. Okay. And then there are also medicinals that we can use only in severe issues and those tend to be their peptides that stimulate contraction of the bowel or their prostate glands which essentially stimulate some changes in the bowel for it to feel a need to move. And then we have the old fleets, enomas and all those other things that really kind of work on bulk. Okay. The bulk concept. And I can tell you I have tons of lady patients that literally cannot. Cannot after years and years go to the bathroom. So some people literally do a colonic every day. Okay. I know some women that go once a week and get colonics. Okay. Some women just have no matter how much we try, we cannot get that by working. Wow. So in that situation, chronic constipation has a very definitive definition and I think it's three months. Okay. Remember right? It's three months of certain symptoms that are typical of constipation. But I'm telling you it's a huge issue. But I think that what we're focusing on, you know, when you're constipated and it's bad, you are miserable. So you're going to the doctor to get immediate help. Yeah. You're not going to the doctor to say, oh, give me something to help me next week. Yeah. It's time. And so I think we need to separate it from problems acutely and how we treat those. But then we can't stick with those. If we stick with those, we tend to make the bowel really lazy. Yeah. And the bowel gets just like a muscle that we don't use. It gets weak and then it starts needing that all the time. Yeah. And that's what a lot of these people have gotten into. Yeah. But I think that when we approach it as doctors, I think we're really bad of just printing a prescription or making a recommendation, handing it to them and saying, good, we'll see you later because we just want them out of the office. I hope it works for you. But we ought to think more about what can we do since this person got here to essentially change the habitus of the bowel, okay, whether it's habits, whether it's social issues, you know, go into the bathroom when you're supposed to is actually very important instead of holding it like one and two till they get home. And you guys are really bad about that. And I don't mean that ugly. But it seems to me that it's more of an issue with female. Yeah. We also want to look at getting the right probiotics in the bowel to actually make some of these agents to help us. Okay, so it turns out there are certain probiotics that literally can be made to help constipation. That we can make a blend that essentially creates all the things that we know that can help it. But when you get to the prescriptive agents and the standard agents of laxatives, mirror lax and stuff like that, and those can be highly abused. And this create a lot of times a create instant relief. But I think they create more chronic problems than they should. I mean, you literally could probably make your practice out of constipation. You can just be a constipation doctor. And I think you would probably be very successful. Because it's that complex. Well, already this was a hefty topic about the gut microbiome and all the things within the digestive system. We want to thank you all for joining us for part one of tummy trouble. Make sure you tune in next week for part two where we dive into more details on symptoms and then also the lifestyle change that you have to make as well as a little bit on genetics. So thank you all for joining us for another episode of Coffee with Dr. Stewart. Make sure you follow us on all of our social medias and tune in for our next episode. Thank you and be blessed. This show is for entertainment purposes only. Please do not use anything mentioned in this show as your own medical advice. Please discuss all medical issues with your own provider.