#168: Dr. Robynne Chutkan: Dirt, Sweat, and Veggies - To Fortify Your Gu
Are you on meds for acid reflux and indigestion?
Do you take antibiotics or birth control?
Do you enjoy artificial sweeteners in your coffee?
Do you drink alcohol on a regular basis?
These are all ubiquitous substances in our society at this point, but they are also posing a threat to our immune system.
Multiple studies show that antibiotics, medicines, and substances like alcohol and sweeteners actually reduce the amount of stomach acid in your gut, wreak havoc on your gut microbiome, and actually increase the likelihood of getting hit hard by viral illnesses like COVID-19.
So what in the world can we do to prevent this?
Gastroenterologist, Dr. Robynne Chutkan, is back with her latest book, The Anti-Viral Gut: Tackling Pathogens from the Inside Out and that is exactly what she and Rip discuss today.
Why are some people more susceptible to contracting these new viruses, and what practices can we do to minimize that risk and boost our immunity?
Dr. Chutkan is a powerhouse of research and information in this interview, and they start with the basics:
What exactly are the gut and the digestive tract?
Why do so many suffer from dysbiosis, which is a damaged gut microbiome?
What makes some of these commonly-prescribed meds so bad for our gut lining?
Once we learn “the why,” then we can take action and that’s what the second half of the interview is all about. Dr. Chutkan shares her Top 10 Guidelines to boost your defenses and overall health.
It’s a jam-packed session of research and science, but also hope. Our bodies heal at an enormously rapid rate if we provide the assistance it needs. According to Dr. Chutkan. those key elements include plenty of dirt, sweat, and whole lotta veggies!
Episode Timestamps
17:26 Why write “The Anti-Viral Gut” Now?
26:40 What are PPIs and what percentage of the population is taking these drugs to treat acid reflux and indigestion?
28:30 People believe (because of marketing) that their stomach is producing too much acid and so they need these meds. This isn’t always true. What’s actually the cause of the discomfort?
31:42 Digestion 101 - What are the gut and the digestive tract?
39:22 Short Chain Fatty Acids- What are they and why are they so important?
45:30 What happens when you don’t have enough short-chain fatty acids to provide energy to the cells of the gut lining?
52:55 Disbiosis of the gut -What is it and why is it happening? What did the American Gut Project show us?
1:05:11 Robynne’s 1-2-3 system for getting more fruits and veggies
1:07:45 Birth control pills, artificial sweeteners, and alcohol -How do those affect the gut?
1:20:55 The cascading effects of stress and lack of sleep on our microbiome and immunity
1:27:30 The OAF - The Open Air Factor - The importance of getting outside
1:29:35 Dr. Chutkan’s Top 10 List for health and longevity
1:49 Robynne’s ‘Ride or Die’ Guidelines for optimized health
Episode Resources
Order The Anti-Viral Gut
Follow Dr. Chutkan on Instagram @gutbliss
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Rip Esselstyn:
Hello, Plan Strong pod squad with Thanksgiving right around the corner, I don't want any one of you to be left in the lurch when it comes to bringing some sort of incredible holiday recipes to either Thanksgiving or Christmas. So, we have created the Plan Strong holiday guidebook. If you guys don't have a copy, you definitely want to get one. It's free. It rocks. It's incredible. Some of the recipes in this guidebook are cranberry salsa, holiday stuffing, Mommy's mushroom gravy, cauliflower pot roast, a pumpkin and white bean soup with roasted brussel sprouts. We also have a sweet, holy deliciousness soup. We've got a crazy lineup of desserts, berry crumble cookies, guilt-free apple crisp reindeer crunch cookies and plants drawn pumpkin pie. So check it out. Simply visit our show notes in today's episode to download your free holiday guide today. Yeah,
Dr. Robynne Chutkan:
Part of why this drug is so popular is because it is incredibly good at what it does. This drug is magic, right? It shuts down that proton potassium atpa. It's That proton pump, and it creates, quite frankly, a medical condition called achlorhydria, meaning no stomach acid. So when you don't have stomach acid, yeah, you can eat that big meal late at night and there's no acid coming up. But guess what? You've profoundly interfered with digestion. Having stomach acid, it's digestion 101, I mean, that is the ideal pH for the enzymes to work, for the pancreas to release its lipase and amylase for the gall, for everything, for absorption of fat soluble vitamins like A, D, E, and K. So when you block stomach acid, you really interfere with digestion. You interfere with assimilation and absorption of nutrients. And that's why these drugs long term are associated with so many problems with increased fractures and kidney problems and cognitive problems.
Rip Esselstyn:
I'm Rip Esselstyn, and welcome to the Plant Strong Podcast. The mission at Plant Strong is to further the advancement of all things within the plant-based movement. We advocate for the scientifically proven benefits of plant-based living and envision a world that universally understands, promotes and prescribes plants as a solution to empowering your health, enhancing your performance, restoring the environment, and becoming better guardians to the animals we share this planet with. We welcome you wherever you are on your Plant Strong journey, and I hope that you enjoy the show.
Okay, my rock star audience, we're going to start the show today with a pop quiz. So first, how many of you take meds for acid reflux and indigestion? Okay. Next, how many of you are on antibiotics or birth control? How many of you love to put artificial sweeteners in your coffee? And lastly, how many of you drink alcohol on a regular basis? N.
Ow, my bet is that most of us raised our hands for one or more of these questions. And here's the thing, modern medicine is wonderful and it can be very powerful. And as most of you know, I'm the son of a doctor and I understand how medicine provides tons of tools and innovations that can help people live better, and in many circumstances, survive. But what I want you to be aware of is that multiple recent studies are showing that these antibiotics and medicines to specifically treat acid reflux and heartburn actually reduce the amount of stomach acid in our guts, wreaking havoc on our gut microbiomes, thereby increasing the likelihood of us getting hit, and hit hard by viruses like Covid-19.
So what in the world can we do to prevent this? Enter gastroenterologist, Dr. Robynne Chutkan, and she is back with her latest book, The Antiviral Gut: Tackling Pathogens from the Inside Out. And that is exactly what we do today. Why are some people more susceptible to contracting these new viruses? And what practices can we do during our everyday lives to minimize that risk and boost our immunity?
Dr. Chutkan is a powerhouse of research and information in this conversation, and we start at the top with the basics, like what exactly is the gut and the digestive tract? Why do so many of us suffer from something called dysbiosis? Which is a term that describes a damaged gut microbiome. And why are some of these commonly prescribed meds so bad for our gut lining? And once we learn the why, then we can take action steps.
And that is what we do in the second half of this interview. Dr. Chutkan shares her top 10 guidelines to boost her defenses and overall health. So the first half of this conversation is really more of an education, and the second half is actionable. It's a jampacked session of research and science, but also of hope. Our bodies heal at enormously rapid rate, providing we give it the assistance that it needs. And according to Dr. Chutkan, those key elements include dirt, sweat, and a whole lot of vegetables. It's time for us to start rolling around and making it happen. Enjoy.
Hey everybody, I am here today with Dr. Robynne Chutkan. And boy, oh boy, am I excited to have Robynne on the show today. I don't know how many of you know Robynne, Actually, Robynne, you were on the first season of the Plan Strong podcast because you came to Plant Stock 2019 in Black Mountain.
And while you were there, we recorded that lecture that you gave and we actually rerecorded that as a podcast. But this will be my first time actually having a really lively conversation with you. So this is going to be great. So you are, as my sister Jane said, on the back when she endorsed the Anti-Viral Gut, she referred to you as the fairy godmother of the microbiome. Which I think is so perfect. And you've got this new book, "The Antiviral Gut: Tackling Pathogens from the Inside Out" that I really want to unpack with you today and I look forward to it. You cool with that?
Dr. Robynne Chutkan:
I just want to say I am so cool with that. And all things Esselstyn, I am down with, I loved that experience at Plant Stock, and I think I mentioned this to you that after that conference in Asheville, North Carolina, and after they debuted Game Changers at that year in 2019, before it came out on Netflix and all the amazing people who spoke. I think I told you the story that my husband, we left, We had to come back to pick our kid up from camp and we were flying out of Charlotte, and he was not plant-based at the time. He ordered a Porter House, foie gras, and he was like, "Okay, that's it, I'm done." And then he became plant-based after that and his cardiologist fired him and was like, "Okay, so you have a calcium score of zero. You're beating the Georgetown basketball team on the stress test and don't come back." Because his cholesterol drop from 240 to the 160s.
And here's the thing, my husband, when I married him, and even before when I met him over 20 years ago, he was so worried about heart disease because his father had had his first cardiac event in his fifties and had several more heart attacks and died in his seventies from a cardiac event. And I would say to him, "Look, you're super fit. You run trails. You're not diabetic, you're not a smoker, you're not hypertensive, you're not sedentary. The only risk factor you have is your family history." But he was still always wanting to check his lipid profile. And he went plant-based, I have to tell you, he is not a hundred percent vegan. He will eat some animal protein from time to time, but he, I'd say he's 99%. And if he does, if it's a holiday time and he eats some Turkey or something, he always says, "Oh, I just can't wait to get back to my diet."
Which is basically his big bowl of oatmeal in the morning with a ton of different plants, his huge salad at lunch, and then his saute greens and brown rice and more salad in the evening. And so he just feels fantastic. I mean, there's no convincing him that this is the way to eat. He just feels so great. And I don't think he's worried about something that he literally used to get up in the morning with, in the back of his mind about the heart disease is just not there anymore. So in addition to us having a great time, I want to really thank you for that because it was transformative for him.
Rip Esselstyn:
Yeah. Well, we loved having you. And as I think you said, these are your kind of people and it was truly, it was a great weekend. You're in Washington DC right now, right?
Dr. Robynne Chutkan:
That's right.
Rip Esselstyn:
And so tell me this, do the cherry blossoms only blossom in the spring? Is that how that
Dr. Robynne Chutkan:
Works? No, we kind of have a second blooming in the fall too. And I'll tell you what's really interesting about the cherry blossoms. So DC is a beautiful city and I'm very proud to live in Washington. I've lived here 25 years, which is the longest I've lived anywhere. And I consider myself Washingtonian. But cherry blossoms are not original to DC. As you know, they were a gift from the Japanese government. And as a result of all this beautiful foliage, including the cherry blossoms, DC is also the allergy capital of the US because a lot of the plants, like the cherry blossoms, are not indigenous to the area. And so people tend to develop antibodies to them. So they're amazing to look at. But whole lot of sneezing going on around here with the cherry blossoms. And of course everything for me, I'm like a hammer. Everything points to the gut, right?
The really interesting connection between seasonal allergies and what's going on in your gut in terms of your microbiome, the integrity of your gut lining, et cetera. Something that I have to say, 25 years ago when I moved here, I didn't really think about the whole sort of gut allergy connection. But yeah, it's a beautiful city. The cherry blossoms, primarily the spring, but again, there is kind of like a second blooming. And DC is just amazing right now in the fall with the foliage I was showing you, I was spinning my camera around to show you the amazing. We live right on the edge of Rock Creek Park, the amazing forest, But just all the beautiful parks and green areas. It's amazing.
Rip Esselstyn:
Well good. Well that's a good plug for coming to DC.
Dr. Robynne Chutkan:
Definitely. Come on.
Rip Esselstyn:
I know whenever I'm there, I always adore it. There is. It's got a certain energy and buzz about it for sure. Now, before we dive into the antiviral gut, I want to ask you a couple questions. When we were at Black Mountain, I think you mentioned you were getting ready to do a triathlon or something like that. Did you ever do that?
Dr. Robynne Chutkan:
Yeah, I was getting ready to do a half Iron Man, the Eagle Man in Chesapeake, Maryland. And then I herniated three discs in my cervical spine. I got to assume it was a tri-bike. I've been fitted and everything for it. So I was not able to do that, unfortunately. I'm mostly a runner. I can swim. I'm slow. I don't love the bike, Rip, I have to tell you. And the bike is the majority of the time. But I can run for sure. Getting ready to do the Philly half marathon in, I guess in mid-November. And my full marathon days may be behind me. I don't know. We'll see how the knees hold up. But I still love just to get out there and run far and slowly.
Rip Esselstyn:
Well, I also saw in researching you that you also like yoga. You still doing yoga?
Dr. Robynne Chutkan:
Oh, all the time. Yeah. I go to my yoga home here in DC is called Down Dog Yoga. It's a great studio. And what's been fantastic is our daughter, 17 year old, has been coming, I think it's maybe the stress of senior year, but she normally is somebody she does not love the heat. She spent a messed up in Vermont in high school, loved it. And Down Dog Yoga is heated Vinyasa flow, so it's not as hot as what you think of hot yoga as Bikram. But it's a gentle 99 degrees, sometimes gets up to about 102. And it's a super athletic form of yoga, the Vinyasa flow Baptiste style for those who are interested. So I do try and make it there two or three times a week. And I love going at this time of year as it's getting colder. I mean, heated yoga in August in DC is a much harder sell, but this is a great time as it's kind of getting crisp outside.
Rip Esselstyn:
Yeah, I think I just mentioned to you, I just got done doing a six day retreat in Sedona, Arizona, and we have yoga every morning. I did yoga three times a week in the 1990s. And I just loved how I felt. I got away from it, Life got busy, but I did it every morning. I can't believe how fantastic my body feels after just giving it that gift of stretching and strengthening. And then also just the mental kind of unpacking that happens when you do that yoga practice.
Dr. Robynne Chutkan:
Absolutely. Absolutely. It's so great.
Rip Esselstyn:
And you also, you play squash? Do you still do squash?
Dr. Robynne Chutkan:
You know, I-
Rip Esselstyn:
Cause that's such a unpopular sport.
Dr. Robynne Chutkan:
It's popular in the Commonwealth where I hail from. So I was born in Jamaica, lived there until I was 14, and then my family moved to The Bahamas. And I was in school there for a little bit. But I also spent some time in high school in France and Spain, and then came to the US at 17 for college. And I played squash in college. I was bottom of the team. I will say we had a really good team, and my whole family played, my 87 year old dad and my 82 year old mom. I mean, my dad still plays tennis and squash. So my sister played in college. I played squash. My brother was a tennis player. So my whole family plays racquet sports.
But here's the thing, it wasn't really popular back then when I was in college in the eighties at all. I mean, people would see me and be like, What is that a badminton racket? But squash in areas where you have a big expatriate community, like in DC, squash is big. So the squash club, I go to Squash On Fire, we've got people from Pakistan and Egypt and India and Australia and the UK and Canada and all over, Argentina. It's sort of, because it's a sport that originated in England, they kind of spread to the colonies. So it's like a little UN of squash players. And now pickle ball, right? Everybody's playing pickle a ball, which-
Rip Esselstyn:
It's a phenomenon.
Dr. Robynne Chutkan:
Yeah.It's crazy. Well, the reason squash really caught my eye is my last two years of high school, I went to a boarding school called Mercersburg Academy. It's about an hour and a half from DC.Great squash team.
Rip Esselstyn:
Great squash team. So I knew a lot of the squash players. I was a swimmer, but I played a fair amount and just grew to love and really respect and admire of the sport. It's really cool.
Dr. Robynne Chutkan:
In fact, an organization I was on the board of a squash and education alliance that works to bring squash to areas, in cities in particular, and to expose squash to people who might not otherwise have the opportunity and use it as a vehicle to get kids into, get them scholarships, to high schools and to college. So we had a camp at Mercersburg during Covid for SCA. Yeah. So they're a well known squash high school. As you probably saw, there's an athleticism associated with squash where you could take a squash player and they can could probably participate in a couple different sports because you have the hand-eye coordination, you have the quickness, the speed, the endurance, all of these things. I don't necessarily have all of that, but the game.
Rip Esselstyn:
And for those of you that have no idea what squash is, it's kind of like racketball, but with a really long racket with a smaller head than a tennis racket. And it's a little ball. It's like the size of a golf ball and it doesn't bounce that much, but just enough to make it very exciting. And you can use all four walls. It is brilliant. It really is.
Dr. Robynne Chutkan:
Yeah, it's a great game.
Rip Esselstyn:
Yeah. All right, let's dive into your new book. You cool with that? Okay.
Dr. Robynne Chutkan:
Oh yeah. I think I have some time to talk about the new book.
Rip Esselstyn:
Okay, so first let me say I can't believe how much buzz there is right now around the microbiome. It is everywhere I turn, it's like gut health, microbiome this, microbiome that. I've had. Dr. Will Bulsiewicz and Dr. Allen Desmond on the Plant Strong podcast, gastroenterologist.
Dr. Robynne Chutkan:
They're both great. Yeah. We're a small club, gastroenterologists who really believe in food as medicine, But Will and Allen are both fantastic.
Rip Esselstyn:
But you've written several other books, Gut Bliss, you've written the Microbiome Solution, The Blot Cure. So tell me this, and I think it's pretty apparent, but why now? Why the Antiviral Gut?
Dr. Robynne Chutkan:
I'll tell you, Rip. I thought I was done with book writing. Gut Bliss was 2013, Microbiome Solution was 2015, Bloat Care was 2016. And I was like, "I kind of feel like I've said what I have to say about digestive health." And then came the pandemic, and then came a series of really interesting articles. So the first one was Summer 2020. This was a population based study where they looked at about 53,000 patients and they asked a simple question. The simple question was, in people taking acid blockers, a specific type of acid blocker called a proton pump inhibitor, are people who are taking proton pump inhibitors more likely to get Covid? And the answer wasn't just yes, it was a resounding yes. It was to the tune of if you're taking a proton pump inhibitor once a day, you're twice as likely to test positive.
And if you're taking a proton pump inhibitor twice a day, three to four fold increased risk. Now this didn't really surprise me as a gastroenterologist because I know that blocking stomach acid means that you have removed one of your really important host defenses, which is the ability of stomach acid to unravel viral protein and stop a virus from infecting cells. And we've seen in the GI world, we've seen increased risk of other viral infections, of rotavirus, of norovirus, even bacterial infections like clostridium difficile and campylobacter.
So any of these, what we call enteric infections that affect the gut, we know that if you don't have stomach acid, you're at high risk. Not just more likely to get infected, but more likely to have more severe symptoms. So it didn't really surprise me, but I asked my husband, who is not in medicine, who, as you know, Rip, is in the super secret spy world, or used to be. Now he's cybersecurity, but used to do counter-terrorism counterintelligence.
So he's not in the medical world. And he listens to me buzzing about this stuff. But I said to him, I said, "Hey Eric, you know that if you don't have stomach acid, because you're taking Nexium or one of these PPIs, that you're more likely to get Covid, right?" And he looked at me and he was like, "What? He's like, No, I don't know that. How does that work?" And I explained, I said, "Because stomach acid, often the virus gets in through the mouth you ingested and the stomach acid unravels of viral protein, renders a virus inactive."
Rip Esselstyn:
Brilliant.
Dr. Robynne Chutkan:
He was like, "No, I didn't know that." And then I asked a couple of my colleagues, I asked a dermatology colleague and a friend in internal medicine. And they were also like, "No, we didn't know that." And then. Rip, I asked one of my GI colleagues and he didn't know that.
And I was like, "Okay, people need to know this." So then I chatted with my book agent, who I've done all the books with, and he was like, "Yeah, you should write an editorial. Let's write a piece for the Atlantic or HuffPo, or something and get that information out there." So I was thinking about that. And then another article came out a few months later. And this article, essentially the same study done in China and also in the US where they looked at what the most accurate predictor of outcome from Covid was and hospitalized patients. So they are like, "Okay, in people are hospitalized with Covid, what is going to tell us with the most precision, whether somebody's likely to have respiratory distress, be on a ventilator, be in the ICU or die?"
And the test that told us that, with 92%, accuracy was simple analysis of the microbiome, looking at schmear of stool. More accurate than looking at comorbidities like heart disease, lung disease, et cetera, age, gender, even inflammatory markers that you would do in the lab like C-reactive protein, et cetera. More accurate than all of those things combined. And what they found-
Rip Esselstyn:
Isn't that crazy? That's crazy.
Dr. Robynne Chutkan:
Is it crazy? Right? A piece of stool. And what they found, I know it won't surprise you as an avid advocate for plants, but it's still. So when you think about what is encapsulated in the microbiome, everything about you, where you were born, how you were born, what you've eaten, the medications you've taken, stress in your life. When you think about it that way and you remember that your microbiome is a more unique identifier of view than your own DNA, then it starts to make sense. But the simple thing they found was that people who had high levels of my favorite bacteria, faecalibacterium prausnitzii, F-prausnitzii-
Rip Esselstyn:
Rolls off the tongue,
Dr. Robynne Chutkan:
I love it. How do you get high levels of F-prausnitzii? By eating lots of plant fiber and high levels of F-prausnitzii were very clearly correlated with better outcome, and low levels with worse. And again, when you look at the central role of diet, high fiber diet, bacteria metabolize a fiber to short-chain fatty acids. short-chain fatty acids guide and modulate that immune response, setting it to the just right level and also maintaining the lining of the gut, keeping viruses out of your body. Because how does this stuff get in to wreak .havoc? It often gets in, it penetrates that gut lining. And they found that high levels of another bacteria, a not so good one, enterococcus faecalis, that is associated with postop infections and that can penetrate the gut lining. High levels of that bacteria were associated with the worst outcome.
So in my practice, I will see patients from all over and they'll come in and sitting there and I'm like, "How do I make eat more vegetables sound really sexy," and it's worth the visit from Maine or Morocco or wherever this person has come from to give them as my... If they've come and they've come for, they want the answer. And the answer is, eat more vegetables. I mean, that's not the only answer, of course, right? But that is so often such a huge part of addressing what's going on in the gut. Whether you're dealing with somebody who has inflammation like a serious autoimmune disease like Crohn's and ulcerative colitis, and you have to be innovative in how to get that fiber into them because a colon is really inflamed. Or you're dealing with somebody who has colon cancer and is worried about recurrence. Are you worried about you dealing with somebody who has reflux, or diverticulitis and frequent episodes? Or whatever it is, so much of what helps the guts stay healthy is maintaining these high levels of plant foods that result in high levels of these post metabolite, short-chain fatty acids. And nowhere is that more true than when we look at that gut immune relationship.
And so we have fantastic things in our arsenal of medical tools. It's fantastic that we do have ICUs and ventilators and monoclonal antibodies and vaccines. And all of this stuff is incredible, but we also don't want to forget about these important host defenses like stomach acid, like our gut lining, like our gut microbiome, and what a pivotal role they play. Prognostically, we see that in all these studies. We see the importance of having intact host defenses. So for my very long answer to your really good question, Rip, I thought I was done. And then the pandemic happened and I realized that there was great public health messaging around social distancing, hand washing, vaccines, but there really was no messaging around what can you do? What can the individual do? And of course do all of those things that all the public health guidelines certainly recommend following them.
But there are so many additional things you can do to improve host health, which is as important as the potency of the pathogen you're facing. If you are an unhealthy host and you have a compromised gut, which is going to compromise your immune response, chances are you're not going to do as well. And there are lots of things that you can do and even on doing. Because one of the things that I see in my medical practice, and it's very much reflected in this book, is that people think the answer is, "Okay, tell me what pill to take. Tell me what supplement to take."
And there is a role for that, right? There are certainly medications depending on if you have an illness that can be helpful. But so often when we're talking about host defenses and optimizing them, so often what we're really talking about is undoing something that somebody's doing that is potentially causing a problem. So thinking more judiciously about the antibiotics that are wiping out your microbiome, thinking more judiciously about the ibuprofen that is potentially making holes in your gut lining and making it more permeable, and really thinking more carefully about how much fiber you're eating, how much water you're drinking.
All of these things. So it's less about going out and finding this sort of magic potion and more about understanding how these defenses work and what you can do to optimize them and what you should not do to sabotage them.
Rip Esselstyn:
Yeah. So I want to dive into a lot of what you just said in more detail, but before we do so, I'm going to go back to the very, very beginning how you started this with PPIs, right? And how they disrupt the stomach acid and the unraveling of that virus. What percentage of Americans do you think are on PPIs?
Dr. Robynne Chutkan:
Well, they used to be the third most commonly prescribed drugs. I think Viagra booted them from that lofty position several years ago. But these are drugs that the CDC estimates that maybe half of these prescriptions are unnecessary. And in older people, who are also more prone to poor outcomes because they're generally mounting a less robust immune response, in older people, there's a British study that says 80% of the older people taking PPIs are taking them unnecessarily. So if we think about what the actual indications are for a proton pump inhibitor, it is that you have an ulcer and that you're trying to heal. And that's typically an eight week indication. It's not an eight month. It's not an eight year as we see people taking them. So it's a pretty finite indication. People who have very refractory reflux, who have failed diet and lifestyle.
So this is after you've done all the things. You've raised the level of your bed. You've cut down on the caffeine and the alcohol. You've cut down on the fat in your diet. You're eating earlier meals, smaller meals. You've done all of that, and you still have really refractory reflux. That is a small group. People who have a pre-malignant condition in the esophagus called Barrett's Esophagus, and what we call long segment Barrett's, which means that a significant amount of their esophageal mucosa has been replaced by these potentially precancerous cells. That's a pretty small group. But here's the thing, Rip, people think as a result of the marketing that they need to take a proton pump inhibitor because her stomach is over producing acid. And that is totally incorrect. There is a condition called Zollinger-Ellison syndrome that is a rare condition about one in a million people, which means about 350 people in the US have this, right?
Where we're actually over producing acid. And Zollinger Ellison is a clear indication for a proton pump inhibitor. But the vast majority of people who have reflux symptoms have inappropriate opening of that valve, that lower esophageal sphincter. And why is it opening inappropriately? Because they're overfilling their stomach, or they're eating late at night when the stomach, contractility. Stomach has a bedtime. So once it gets dark, that contractility comes to a standstill. And if that's when you're eating your large meal and then lying down when you don't have gravity helping move things through, you're going to overwhelm that sphincter. If you're having a lot of coffee, you're going to overwhelm that sphincter. Alcohol and chocolate, I hate to break it to people, can do that. But when we look at reflux and who's having reflux, the dietary contributions are huge. And if we can get people to work on that, it doesn't mean that you have to eliminate everything, right?
But cut down, have your large meal earlier, things like that. We can eliminate the need for this drug in a lot of people. And part of why this drug is so popular is because it is incredibly good at what it does. This drug is magic, right? It shuts down that proton potassium atpa, that proton pump, and it creates, quite frankly, a medical condition called achlorhydria, meaning no stomach acid. So when you don't have stomach acid, yeah, you can eat that big meal late at night and there's no acid coming up. But guess what? You've profoundly interfered with digestion. Having stomach acid, it's digestion 101. That is the ideal pH for the enzymes to work, for the pancreas to release its lipase and amylase for the gall, for everything, for absorption of fat soluble vitamins like A, D, E, and K. So when you block stomach acid, you really interfere with digestion.
Dr. Robynne Chutkan:
So when you block stomach acid, you really interfere with digestion. You interfere with assimilation and absorption of nutrients. And that's why these drugs long*term are associated with so many problems with increased fractures and kidney problems and cognitive problems, because you are interfering with the delivery of nutrients to these other organs. And then of course, they also make you more susceptible to pathogens, bacterial and viruses. And they mess up your microbiome because instead of having acid up top and fewer bacteria there in the stomach and then less acid as you go down to the colon and more bacteria, they change that gradient.
And now you don't have the acid in the stomach, you get overgrowth of bacteria there. So there was a study published in one of our GI journals called Gut several years ago, and that study showed that people were taking long-term proton pump inhibitors and I think they define that as more than two months at a time or might have been four months. But people taking these drugs long-term had a microbiome that was all messed up. They were seeing oral anaerobes in the colon and they basically concluded that long-term PPIs were as deleterious to the gut microbiome as long-term antibiotics which was pretty shocking. Pretty shocking.
Rip Esselstyn:
Well, okay, so you've mentioned digestion 1001. I would love for you to go back and let us know, give us a little review the gut. What actually is the gut, what organs comprise the gut?
Dr. Robynne Chutkan:
It refers to when we think about the digestive tract. And first of all, I just love geeking out on this stuff. So thank you so much for giving me the opportunity.
Rip Esselstyn:
No, well, it's very apparent you are going to town.
Dr. Robynne Chutkan:
I love this. You do a little show and tell later, but no, in all seriousness. So the gut refers to this digestive superhighway if you will, from your mouth to your anus. So if we take a little trip down there, we start with a mouth and digestion starts to occur before anything even lands in your mouth because just the sight of your fantastic food on Instagram Rip for example, will get somebody salivating and that you start to get salivary enzymes, start to get released in your mouth even before by the sight, the sound, the smell, sometimes even the thought of the food.
But so the food gets into the mouth, it travels down this tube called the esophagus. And the esophagus stuff travels down through these waves and then it travels through the lower esophageal sphincter, which is a valve between the esophagus and the stomach gets into the stomach and the stomach has different enzymes being released, pepsin, et cetera, gastrin. The food gets churned up into what we called chime, C-H-Y-M-E, little particles. The chime gets pushed down into the small intestine. Small intestine has three parts, Duodenum, jejunum and ileum.
And in medical school we remembered it as dogs jump in. That was our. Don't ask me who came up with that. I think it was one of the ortho guys. But dogs jump in. So duodenum first part that is connected to the stomach, middle part, jejunum, not a ton happens there. Ileum the last part, a lot happens there like B12 gets absorbed, et cetera. So during that transit time through the small intestine, that's where a lot of the nutrient absorption happens. Things move through the lining, this highly selective fishing net permeable membrane that lines things and then by the time the stuff and then bile of course gets secreted.
It's made in the liver, stored in the gallbladder, gets secreted to help. Bile is detergent for oil, right? If you have an oily plate and you wash it and you may not be able to, well you wouldn't Rip, because you're not using oil in you're cooking. But let's say there is some oil on the plate and you're washing it and you can't get the oil to dissolve but you put the detergent on it and now all of a sudden it emulsifies the oil and you can get the oil off the plate.
Well bile helps to emulsify the fat so that they can get absorbed through the lining. So then, now this stuff gets to the colon, which is also called the large intestine. And at this point it's sort of this greenish liquid, this bullous liquid because it has all this bile in it and of course it has dead bacteria, red blood cells, et cetera. And it gets to the colon. The colon, there's not really absorption of nutrients happening in the colon. The main thing that's happening in the colon, is reabsorption of water back from this greenish liquid stuff through the lining of the colon so that the end, you end up with this brown, nice chocolatey brown solid stool.
So the colon is really an organ where water gets reabsorbed. And that's why in some patients with ulcerative colitis who have their colons removed, they end up with more frequent and more liquid stool, but their nutrient absorption is intact because that's mostly happening upstream. Not suggesting, that anybody should remove their colon. But what I'm saying here is that you can tolerate that more easily than if a lot of your small intestine is gone. But Rip hair, hair is the most fascinating thing I think about all of this. And I graduated from med school in 1991, so I've been a gastroenterologist a long time, but I never thought about this until about 10 years ago.
When food is in your GI tract, it is actually not in your body. It's in this hollow tube that runs from your mouth to your anus and dissects your body. It's outside, it's your environment, everything you swallow and ingest all that food, whatever the pollen, the viruses, the bacteria all of it is in this hollow tunnel running through your body. And in order for it to get into your body, it has to get absorbed through that gut lining. That gut lining is one cell thick razor thin. And it is the only thing protecting you from the outside world. From as I was telling somebody the other day from the dare repellent, I swallowed the other day when I picked some greens from my dad lives a couple miles up the street and he grows this green indigenous to Jamaica and to Washington apparently called Callaloo.
And it's fantastic, it's like a cross between collards and spinach. And I picked some and I'm fond of not washing the stuff because I'm like, "Oh yeah, dirt's good for you." Well, yeah, dirt, but not deer repellent that he had inadvertently sprayed on it. So my gut lining protected me from this deer repellent stuff. So the point is it is really the... It's in contact with the environment and your gut lining has to be, when it is intact, it serves as this permeable but highly selective membranes so that it is keeping out the toxins of viruses, the poorly digested food particles, the deer repellent.
And it is allowing the fully broken down nutrients to pass through and be assimilated and carried to the rest of the body. And similarly, it is allowing the cellular waste debris to be excreted into the gut. And so how do things get into our body? Often through a breach in this membrane, rght?There's an increase in permeability and that's non-steroidal anti-inflammatory drugs do. In addition to helping your torn MCL feel better. Unfortunately the price for that is they are making these little holes when they're big holes we call them ulcers and we can see them with our endoscope. But little tiny holes that increase the permeability of the gut membrane.
Rip Esselstyn:
Okay, you say so much and I want to ask you so many questions. So first, I'll say Dr. Klaper likes to say, "We're not what we eat, we're what we absorb." All right. And it sounds like based upon what you said right there, you probably would agree with that very much so. And I've never heard that explanation that it's basically a tube that runs through our body, but it's really the food is, it's not inside us so to speak. It's really outside of us. That's a wild concept.
Dr. Robynne Chutkan:
It is, right. And here I am a practicing gastroenterologist and it took me a couple decades to get to that and I'll tell you to add on to what he said, and he's absolutely right. It's what we absorb. If your gut microbiome is really damaged because these microbes are so involved with that absorption or simulation process, even eating a high nutrient density diet, you may not be fully absorbing stuff if you don't have stomach acid. Again, even eating a high nutrient diet, it may not be absorbed, damage gut lighting. So you start to see how all these different pieces of the puzzle come together to result in optimal health or suboptimal health depending on what's going on in the gut.
Rip Esselstyn:
Yeah. You mentioned short-chain fatty acids. It sounds like you're a huge fan of SCFAs. Yes?
Dr. Robynne Chutkan:
I'm a huge fan of the food that leads to production of SCFAs.
Rip Esselstyn:
Right. I'd love for us to unwind, or I should say rewind because I don't think many people, including myself really understand what are short-chain fatty acids, why are they so important, where do they originate from and what do they feed?
Dr. Robynne Chutkan:
And you shouldn't feel that if you don't fully understand that. Because I think most physicians don't fully understand that so that's perfectly okay. So I would love to start with a couple definitions and the definitions I'd like to go over, and I apologize for people who know this, but is a concept of a pre, a pro and a post biotic. So let's start with the prebiotics. And biotics what we mean, we're talking about biota, we're really talking about bacteria, living organisms when we talk about biota.
So prebiotics are the food that these organisms eat. And so that we're really talking about high fiber foods and what we call Macs M-A-C-S microbiota accessible carbohydrates. So we're talking about things like quinoa and rice and oats and legumes and all of this great plant food. And we're also talking about food high in inulins. So things like garlic and onions and leaks and scallion and oats. So all of these-
Rip Esselstyn:
So thee are all considered prebiotic foods?,
Dr. Robynne Chutkan:
Probiotic foods. These are foods that are feeding our gut bacteria.
Rip Esselstyn:
Got it.
Dr. Robynne Chutkan:
The probiotics are the live bacteria themselves. And in common parlance, when we talk about probiotics, people think about a supplement, a probiotic that you're buying from the store, ordering up the internet and taking. But remember it's the actual bacteria in our gut that we're trying to cultivate, right? We don't need to go and buy these bacteria off the shelf. We have trillions of them in our gut, but we're trying to selectively feed the ones like the F. Prausnitzii that we want to proliferate. And the definition of a probiotic, the World Health Organization definition, it's really the second part of the definition that's really important.
So the definition is, it is live bacteria that when ingested confer a benefit to the host. And that's a tricky part because you can ingest live bacteria, but there is often a big question mark about whether this is actually conferring a benefit to you as a host. Half the time they're not surviving the stomach acid, The stomach acid isn't activating them or you're just pooping them out or they're dying or there's just not enough to really cultivate and recolonize and repopulate in any meaningful way. But guess what? You have this incredible zoo inside you of existing organisms that if you just feed them, you can dramatically increase a population.
So the prebiotic refer to the bacteria. And then what about a postbiotics? A postbiotics refers to the metabolites that these are the products really that the bacteria make, because I like to say we're animated by our microbes. We're like a hive. And the microbes are the bees. So they're the ones making the honey and they're literally the ones synthesizing the vitamins, breaking down the food, training the immune system, turning genes on and off, growing new blood vessels. I mean all of this stuff is that's doing it.
And so again, so much of it depends on the complement of bacteria that you have in the gut. But to get back to the short-chain fatty acids, we know that certain bacteria like F. Prausnitzii are the ones that are primarily metabolizing that fiber and producing short-chain fatty acids. And short-chain fatty acids aren't the only postbiotic, the only important metabolite, but they are arguably the most important one or the most important one that we know of to date. And the reason why is that the short-chain fatty acids, the cells are colony site, the cells lining the intestinal barrier that epithelium the short-chain fatty acids for energy. That's our energy source.
The short-chain fatty acids also guide the immune system to that gold deluxe level. We don't want people talk about boosting their immune system. And I have to remind people, we don't want to hyperactive immune system. That's called autoimmune disease. When you have an immune system that's too active and now it's reacting to your own tissue, right? To your joints and your skin, et cetera, that's rheumatoid arthritis, lupus, et cetera. It can also cause allergies and seasonal allergies and severe food allergies, et cetera so that's an immune system that's set too high.
An immune system that's set too low means that it can't clear viruses, bacteria, other pathogens or the internal cancer surveillance system isn't working because your immune system is also supposed to find those cells that are dividing improperly and weed them out. So now if you have an inactive or a underactive immune system, you're at risk for cancer infection, overactive immune system, you're at risk for autoimmune diseases and allergies.
So the short-chain fatty acids help guide your immune response to set it at just the right level. And we have lots of data and it's all in the book, lots of scientific data showing lots of clinical data showing that high levels of short-chain fatty acids are associated with this appropriate immune response.
Rip Esselstyn:
Now Robynne, here's the thing, all my research shows me that about 94% of America's caloric consumption is coming from animal products and animal byproducts process refined foods and only about 6% is coming from whole plant-based foods. And you're saying that, correct me if I'm right here, "You're saying that those short-chain fatty acids are the byproduct of fiber that are in whole plant-based foods, right? So-
Dr. Robynne Chutkan:
In that 6%, absolutely.
Rip Esselstyn:
.... Yeah. So what happens when you said the epithelium, which is the lining of the gut, right? What happens when, if short-chain fatty acids are the energy source for that? What happens if you don't have a short-chain fatty acids? What does it do? Does it eat itself? What does it do?
Dr. Robynne Chutkan:
Well, absolutely that study that showed that people, they gave, this is a study in mice and they gave them mice three diets. They gave them a high-fiber diet, a high-fiber diet alternating with a low-fiber diet and a low- fiber diet. And only the high-fiber diet resulted in. So it's not just the health of the microbiome, it's also that mucus layer that protects the intestine. And so the mice eating the low-fiber diet, their intestinal lining they started was starting to be auto digested because you didn't have the fiber to help protect the epithelial lining. And even the alternate day chow that the mice got with the high-fiber one day low-fiber the next day wasn't enough to really protect the lining.
So again, without that intact lining, you are defenseless from the external world. And I don't know about you, but the external world is, the external world is beautiful, but there are some threats in it that I would like to be protected from personally. So, this stuff is and you know Rip, I think about this, right? And I am aware, I live in the real world. it is hard. People are to go and get the food and prepared and all of that. And I took my parents, my 87-year-old dad and my 82-year-old mom. My dad grew up on a farm on a sugar cane plantation. Parents grew, his parents are Hindu and they didn't eat beef or pork and the main cash crop was sugar cane.
But they grew a wide array of vegetables they ate, they raised goats and they had mutton once a week. And the other six days of the week, it was plants at which they grew. And he still is a very basic eater. And his typical meal growing up was dhal, which is typically made from split peas and rice and some green callaloo that I talked about, this cross between spinach and collards and maybe some plant in. And so I took him to this new Wegmans in DC. And not to hit on Wegmans specifically. I mean, it's this huge beautiful shiny store with all this stuff in it.
My dad walk, I took him for the first time there last Saturday and he walked around and he goes, "My goodness, how could anybody not be fat in this country, right? How could anybody not be unhealthy?" Now my dad is 87, he still weighs, witty, weighed in high school. He still has the same haircut, also the same crew cut, but he just found it so overwhelming and that anything you wanted, here's a section with the pizza, the bacon, the Chinese food, I mean, it's just all there. I mean, and yeah, there's a produce section, but by comparison, I mean, we all know that the produce section is shrinking while all the other stuff, I mean, you can just pick up anything you want and go home and eat it, right?
And this stuff is all full of fat and sugar and all this other stuff to make it taste good. And it seems easy. And so it is increasingly harder because of the access, the immediate access. And of course pandemic was contributed to this. It made it so that we all could get the food right away on our doorstep. So increasing access to highly processed foods with very little plant matter in them. And it's just a tide of this and it's really hard to fight. And I understand people are busy and this stuff takes effort, et cetera.
But until you recognize that how important this stuff is, and this isn't just a matter of taste buds and well I like this and so on, but this is a direct contributor to your health, to your resiliency, the book is not scary in any way. But I do mention some statistics that I think are important for people to know. And I mentioned them early on in the introduction. And one of those statistics is a study from Duke University from 2021 where they looked in a mathematical model at the likelihood of a pandemic like this one we've just been through. And to some extent you're still going through to have happened.
And they calculated that risk to be about 2% per year. So Rip, what that means is somebody born in 2020 would've had about a 40% chance of this happening by the time it did, right? If we look at the last 50 years, we see there are over 30 new viruses for which we have no real cure or satisfying treatment. Things like Ebola, SARS-CoV-2, HIV, hepatitis C, et cetera. These are all new viruses. And based on other things going on in the world, we know that the rate of these things happening is actually increasing and hopefully we'll be more prepared.
But part of that preparedness it is our public health messaging, our public health infrastructure to be able to test et cetera, but is also how we care for ourselves and the decisions we make on a daily basis. And so I really want people to understand that direct link between what they are eating and their susceptibility to disease. And we have incredible data supporting, this isn't some religious, I want people to eat plants because this is just science at the end of the day.
Rip Esselstyn:
Yeah, it is. And do you have any idea how many Americans have come down with COVID-19? I mean, I would think it's 80% or 90% of us at this point.
Dr. Robynne Chutkan:
Yeah. As you know, Rip, it's hard to know the exact number because there's a huge number who are asymptomatic, didn't test, et cetera. But it's the vast, vast, vast majority of the country for sure.
Rip Esselstyn:
Yeah. And the people that are having a rough go of it, that have gotten COVID and have to be hospitalized but on a ventilator have unfortunately perished from it. You talk about, I think it might have been chapter four, but how the gut is truly, it's our engine, right? And if we have some dysbiosis going on, which I'd love for you to talk about and all the things that cause it, we've already talked a little bit about it with the PPIs, you mentioned very in passing the non-steroidal anti-inflammatory drugs, which I'd love for you to talk about more because I think so many Americans are pop in ibuprofen's and stuff like that without even thinking about it.
Birth control pills, prednisone, stuff like that. Because I look after reading your book, I'm just amazed at how most Americans, they're not giving their themselves a chance because everywhere you look, it's the wrong kinds of drugs that are damaging our gut, the wrong kind of food that is not allowing us to have a really powerful gut. We're not moving, we're not outdoors, blah blah, blah. It goes on and on and on.
Dr. Robynne Chutkan:
Yeah, absolutely. So I'd love to just dive right into dysbiosis a term you used and because dysbiosis is the most important term, I think currently of the 21st century for people to really understand. And what it's referring to is a disruption of the gut microbiome. And that can take many forms. It can take the form of a microbiome that's just not diverse enough, doesn't have enough of the different species that do different jobs to really protect you.
It can be low richness of different species, it can be underrepresentation of some, overrepresentation of others. So there are lots of different forms, but it refers to a disrupted and a damaged microbiome. And as we know, this has so many repercussions. If we look at the gut as the engine right in the center, right? That I like to point out. And then we think about the gut brain access. We know that 80%, 90% of the neurotransmitters like serotonin, the feel good hormone are made in the gut. If your microbiome is disrupted, who's making the serotonin? It's a gut bacteria. If you're taking antibiotics every couple months and you're decimating your microbiome or steroids or birth control pills or NSAIDs or all these other things, what that means is that your serotonin production is going to be affected. That means that your mood is going to be affected.
And we also know that serotonin is a precursor hormone for tryptophan, which is a sleep for, sorry. We know that serotonin is made from tryptophan and serotonin is a precursor hormone for melatonin, the sleep hormone. So now your serotonin levels are messed up, your melatonin levels are messed up, your sleep is messed up, messed up sleep is going to mess up your immune. I mean, it's all connected. We look at autoimmune diseases that affect one in four Americans, and we started out with a couple dozen now are at over a hundred. So things like lupus, rheumatoid arthritis, psoriasis, eczema. These are really common things. In fact, Rip, we've come to accept them.
Rip Esselstyn:
I never even heard of them when I was growing up.
Dr. Robynne Chutkan:
Yeah.
Rip Esselstyn:
Literally.
Dr. Robynne Chutkan:
Absolutely.
Rip Esselstyn:
And now it seems like everybody has some little autoimmune disorder-
Dr. Robynne Chutkan:
Absolutely. I've worked a couple.
Rip Esselstyn:
... going on, and do you think it's purely related to, well not purely, but mostly related to dysbiosis in the gut.
Dr. Robynne Chutkan:
Absolutely. There's a direct correlation between our super sanitized lifestyle. And there's a great, I mean, I talk about this study for years now, David Strong from the London School of Tropical Medicine and Hygiene. So he was tasked back in the 1950s to figure out why they were seeing from back then rising rates of autoimmune disease in kids in the UK, hay fever, which is like asthma basically, and eczema. And he embarked on a 21 year study of over 17,000 kids from birth to adulthood. And he found two really surprising facts that formed the basis of what we call the hygiene hypothesis, which we'll talk about in a minute.
But what he found was that kids who were from large families who were getting coughed on and sneezed on and exposed to the usual childhood illnesses, those kids weren't getting autoimmune diseases later on because their immune system was trained by exposure to these fairly harmless pathogens. The other surprising thing was that kids from wealthier families where they had higher levels of hygiene and back then there was a correlation between wealth and hygiene.
Now, there certainly isn't, but back then in 1950s post-industrial London. The kids who were bathing and washing and super clean had higher rates of those autoimmune diseases. And what's really interesting is if we look at a map of the world today, couple, several decades later, what we see is high rates of autoimmune disease in more developed countries like North America, Western Europe, et cetera, and lower rates in countries like Sub-Saharan Africa, Southeast Asia. But as those countries become more industrialized, as they start to eat highly pesticide ultra-processed food, as they start to use more antibiotics, their rates of autoimmune disease are also rising too. So there is a direct correlation between this super sanitization.
And I think it's important to point out that super sanitization has its benefits too. I'm glad I don't have to worry about getting cholera from the drinking water, right? That's huge. But where the pendulum has swung now to where we're seeing more of these non-contagious diseases, autoimmune diseases, diabetes, obesity, cancer, things like this that are the main threat. So the main threat is in cholera anymore. I mean, we still have tuberculosis and these things and in lots of parts of the world. But in the part of the world where we live, the main threat is non-communicable diseases and really lifestyle diseases.
Diseases that are a direct result of the food that we eat, the way we live. we're sedentary, we're not out in nature. We eat processed foods, we don't eat a lot of plants. All of these things. And these things are very, very, very easily reversible, right? Once people know about it. So I look at the books as public health messaging and I'm happy to say that I'm not trying to sell anybody anything other than some really good advice here and point them in the direction of great products and other medications in the plan.
At the end of the book, I go through these medications you mentioned and I say, "Okay, here's what you can ask your doctor." And I talk about alternate dose schedule, reduced dose. If you can be at 200 milligrams or less of the ibuprofen, you'll probably be okay. Ask them about this version of a nonsteroidal that does, isn't as damaging to the gut lining here. Here's a tapering schedule for your proton pump inhibitor. So it's not just doom and gloom, these things are terrible. Don't do them. But what can you do? Because I mean you are a triathlete. I'm a very slow marathoner and a baby snowboarder. And I've had, I remember tearing my MCL snowboarding in Powdder Mountain in Utah and that thing was excruciating.
And because I don't take this stuff, my husband went and got me some... He got me like 800 milligrams of Motrin. And I took that and Rip, I was like, "This is like magic. I mean, I couldn't believe it. The pain was gone. I was hobbling around. I didn't know how I was going to get back on the plane because I couldn't bend my leg. And I took this Motrin and it was just unbelievable." And immediately I was like, "Oh, this can possibly be good for you." Because it's taken away all my pain, right? What's the price on the back end? And there's definitely a price. So I just want to say I am a huge advocate for all of these medications and techniques that we have, but I want to see them used judiciously, right?And so I'm very critical of the overuse, but I'm very glad that we have, I mean, modern medicine provides so many tools and innovations that can help people not just live better, but they can help people survive who wouldn't otherwise have survived. But we have to use things more judiciously. And we have to reject the idea of these diseases as being normal. And they are for the most part, made, not born. I mean, there is a genetic predisposition for a lot of them. And that's a good segue into another one of my favorite studies from a long time ago, this study by Paolo Lionetti, an Italian gastroenterologist in Florence who looked at kids born in Florence, Italy, eating a diet virtually identical to the standard American diet, lots of animal protein, fat, sugar, et cetera, low fiber.
And he compared them to kids who are living in Bull Pond, Burkina Faso, eating a high-fiber diet, locally grown the mostly tribe living, very much like their neolithic ancestors did. Their main protein source, animal protein source was termites in the rainy season. And other than that, eating mostly plants. And what he found is that at birth and in early infancy, the microbiome looked the same in babies who were born vaginally and breastfed. But as soon as those groups of kids graduated to the local diet, everything changed.
They were seeing half the levels of short-chain fatty acids in the Italian kids and species that were associated with obesity and inflammation, et cetera. And in the kids in Burkina Faso, they were seeing, again, double little levels of short-chain fatty acids and high levels of species like F. Prausnitzii, et cetera, associated with leanness and health. And the really important thing here, Rip, is that we're talking about healthy kids. Neither group of kids were sick, but we were seeing the foundations for disease laid down early on, in early childhood, in toddlers based on the diet. And on the flip side of that is a study from Nature from 2014 where they took nine volunteers in Boston. And they had them eat essentially like an Atkins-type diet, pork rinds-
Dr. Robynne Chutkan:
... and they had them eat essentially like an Atkins type diet, pork rinds, prosciutto. They had them on that diet for about a week, they rested him for five days and then they put them on a plant-based diet, a simple plant-based diet. Jasmine rice, lentils, mango instead of pork rinds for snack. And what they saw is that within about 30 hours of food hitting the gut, the microbiome started to change dramatically. They started to see the bilophila, the bi loving bacteria that need to be around to digest meat drop and some of the healthier species increase.
But that wasn't the really dramatic thing. The really dramatic thing was that they started to see these different genes turned on and off. So for people who feel like my husband, who felt like, "Oh, my father had heart disease, I'm going to have heart disease." The genes are just a suggestion. The genes don't determine our destiny. And you can turn stuff around by changing what you're eating within 30 hours. What you're eating today on a Thursday can be, your microbiome can be different by Sunday based on those choices. And we know from the great work of the American Gut Project, 30 or more different plant foods a week. Will, Allen and I, we always talk about this study, 30 or more different plant foods per week, magic number.
Rip Esselstyn:
And that was a legit study over 10 years, how many thousands people?
Dr. Robynne Chutkan:
Yeah, it was a great study. And over 10,000 people. And the thing I love about that study, it was global. It wasn't like, this is what's going on in Olmsted County, Minnesota, this was a global study. And the other really interesting thing about that study was, it didn't matter what people called themselves, it was what they ate at the end of the day. The proof was in the plate, it was what they were actually eating that was important. And so, I have plenty of patients who will say, "Well Doc, I eat vegetables every day." But they're eating the same peas, carrots, broccoli in heavy rotation. And we know from that study, 10 or fewer different plant foods per week was associated with a much less robust, rich, diverse, healthy microbiome compared to 30 or more. And I remind people too, it's not just vegetables, it's fruits, it's grains, it's herbs, it's spices, you get credit for all of it. It's the pumpkin seeds, the walnut nuts, the berries in your oatmeal, it's not just the oats themselves.
Rip Esselstyn:
Well, in your book, which was phenomenal, I loved reading it. You mentioned how you look at, again, how Americans eat and we're not even, most of us aren't eating one serving of whole grains a day. We're not having, I think one piece of fruit a day, not having two vegetables a day. I mean, it's really ludicrous. And-
Dr. Robynne Chutkan:
Less than 3% of Americans are eating the recommended, and the recommended amount is minimal amount of beans and greens a day, less than 3%. We are eating in a way that is designed to make us sick and susceptible.
Rip Esselstyn:
To dysbiosis, to leaky gut, all these things. You have a system that you recommend for people to start introducing more fruits and vegetables, it's one, two, three. Or, three, two, one -depending upon which way you want to go. Will you tell everybody about that?
Dr. Robynne Chutkan:
Sure. One, two, three is, and I came up with this really over a decade ago in my practice because people got very caught up in how many grams of this and that. And I said, I want you to eat one vegetable in the morning, two at lunch and three at dinner. Just do that. But then after the American Gut Project study came out in 2018, I was like, "Okay, it has to be six different vegetables." And so, whatever you're eating, if you grab a carrot in the morning, that counts as you're one, for two at lunch, that's easy. If you have a side salad with lettuce and cucumber, you're there. And then for three I tell people, have the salad plus another vegetable.
I personally kind of flip it, Rip, I'm a green smoothie kind of gal, I like to get a whole bunch in first thing in the morning. I haven't had mine yet, I'm a little late, but I'm going to go mix it up. And so, I'll do a green smoothie. I do a base of coconut water and then I like to do, typically kale and spinach or kale and collards or collards and spinach, but two kind of robust greens, some callaloo if it doesn't have any darapelent on it. And then I'll typically do a stock or two of celery and then I like to throw in some parsley just for the flavor and then some fruit. So if I have fresh fruit, if it's stone fruit season, I'll use nectarines, I'm a little allergic to peaches, but I'll use nectarines or I'll do mango fresh or frozen, pineapple fresh or frozen. I do the fruit kind of for flavor, ice, blend it up.
I drink that thing, I feel so amazing. That is my medicine. I am 56, I'm not on any medication, that is my medicine, that green smoothie. And so, I know if I get that in the morning, even if the rest of the day sort of doesn't go as planned, I've gotten in some, I've gotten in 30 ounces of blended up greens. And I'm also a big soup person, I'm actually in the midst of making some leak soup with, super easy, it's just leaks, garlic, onion, and I saute it all in a pan and then I put it in the vita-mix with some broth, a little coconut milk, curry powder of course and a little turmeric and that's it and it's delicious.
Rip Esselstyn:
It sounds delicious. I want to circle back to dysbiosis. And if you could touch upon, so birth control pills, artificial sweeteners and alcohol, what are your thoughts and how do those affect or not affect the gut?
Dr. Robynne Chutkan:
Yeah, let's start with birth control pills, because that's a trickiest one and it's one I really struggle with as a physician, as a woman, as a person of color. We know that unwanted pregnancies keep women, particularly women of color in poverty throughout the world, we know that as a fact. Can get in the way of them getting an education. So, preventing unwanted pregnancies is a huge goal for looking at the economics of being a woman, particularly in poor countries.
But at the same time, we also know that birth control comes with some problems, particularly hormonal birth control. And it seems that hormonal birth control in certain people can affect the microbiome, not in everyone, but if you look at the sum total too, if you're also somebody who's taken a lot of antibiotics, maybe been a C-section baby, maybe not been nursed, not had a super healthy diet and then you add that to it. So, it's important to point out that the tolerability of this stuff, it's not an absolute for all of these things, it depends on what everything else looks like. What else is going on in your terrain, what does your soil look like?
But birth control pills can be disruptive to, and hormonal birth control to the microbiome. So that one can be tricky. I also worry about the fertility impact. If you suppress ovulation in a young girl at 16 and you suppress it for 20 years and then at 36 she's trying to have a baby and she's told, "You're not ovulating." You kind of have to wonder, right, we suppressed ovulation for 20 years and now she wants to ovulate and needs to ovulate to get pregnant and she's not ovulating. Is there a connection between those things? So, birth control pills are tricky because, again, of the, birth control pills have liberated woman in so many ways. But I think it's an important discussion to have with your prescriber about looking at your health overall and is this a good idea considering everything else that's going on and whether you have an autoimmune disease or not, what your gut health is like. The other one, artificial sweeteners.
Rip Esselstyn:
Artificial sweeteners and then alcohol.
Dr. Robynne Chutkan:
Let's tackle that one. Artificial sweeteners real easy, because just no, just no, absolutely not. No, no, no. And I'll tell you why. Artificial sweeteners can do, first of all, nothing is free, so you don't get sweetness without paying a price somewhere else. So, if we just talk about the scam that is this idea of zero calories. Yes, zero calories in a calorimeter when you burn it, but not zero calories in terms of weight gain. We know that insulin release, the hormone that controls fat storage, insulin is released in response to sweetness, not calories. Insulin could care less about how many calories are in good food or drink. But when something tastes sweet, insulin levels rise. And high insulin levels are associated with fat deposition. So we know that a zero calorie soda is going to result in the same amount of weight gain as a soda with calories. And we know that. So, we have to just be smarter about that.
So in addition to the fact that it's not saving you calories, and these, in fact sodas in particular and diet sodas are a major risk factor for obesity in this country. We also know that these artificial sweeteners can interfere with the microbiome. They can create more pathogenic bacteria, they can take harmless, benign gut bacteria and cause them to mutate into more harmful bacteria that can penetrate the gut lining. They can also, artificial sweeteners like Stevia, people are always like, "Oh, what about Stevia?" And I'm like, "Unfortunately, Stevia is still a non-nutritive sweetener." And what we know is that some of these newer sweeteners can interfere with communication between gut bacteria. So when you think, I mean it's not a ton of calories, it's like a teaspoon of sugar, come, it was a 15, 20 calories.
And I think once people stop having foods and drink sweetened buy these things, they start to realize these things are super sweet anyway, you don't need it to be that sweet. I eat dark chocolate and I love a 70%, but I try and eat a 77%. When I eat milk chocolate, I'm like, "This is just molten sugar in my mouth, this doesn't taste good." Because I'm used to, to me the 70% is a treat. So it's a matter of adjusting your taste buds.
And then let's talk about alcohol. Before there was antibiotics, there was alcohol as what we used to kill bacteria and sterilizing in the operating room. So alcohol is what we call bacteriocidal, it kills bacteria. And that's why when you go to get your blood drawn, they do the little alcohol swab on your skin to clean your skin and kill bacteria. That being said, there are different amounts of alcohol that your body can potentially tolerate based on what the background noise is. But alcohol is not a health food in anybody or a healthy drink, but you may be able to tolerate it. So if you're drinking a drink every now and again, two or three drinks a week, and you are not taking any other medications that are hard on your liver, you're eating a healthy diet, you're exercising, you're doing all of that. And here's a tricky part and you can keep that alcohol consumption at a few times a week, you may be able to get away with it.
But what we see is that every year the guidelines change. So in the UK the guidelines were, one or more alcoholic drinks in women increase with double the risk of reproductive cancers. Which means, one or more double, so you have to have six drinks or less. In Canada now, their public health authorities have now come out and said, no amount of alcohol is healthy, the healthy amount of alcohol is zero. And so again, this is a very individual decision for a lot of people to really take an honest look at their alcohol consumption and say, "Is this a healthy amount of alcohol?" And I think if you're having six drinks or more per week, anything above that is clearly unhealthy.
And in my patients who have autoimmune disease, so if I'm taking care of a patient with Crohn's and their disease is active and we're trying to get their disease into remission without a biologic, without a steroid, which is always our goal, zero amount of alcohol is probably tolerable in that situation. If you have somebody who has had colon cancer or has a lot of risk factors for it, zero amount of alcohol. So again, if you were a perfectly healthy person with no medical problems whatsoever, you eat a perfect diet, you exercise all the time, you sleep, you do all of those things, could you have a couple drinks a week and probably stay healthy? Yeah, you probably could. But that's not most of us. That's not most of us. If you are somebody with a dysbiosis and you are trying to really heal your gut and improve that microbiome, there's not a lot of room there in the cup for alcohol in that setting because it kills bacteria.
Rip Esselstyn:
Like I told you, we just got back from this six day retreat in Sedona and we don't serve any alcohol there. And it's amazing how many of the participants for the first time in their adulthood have gone that long without any alcohol consumption and have realized, "Wow, you know what? I didn't miss it. I woke up easier. I went to bed easier. I actually laughed more than I ever have." And how really it just, it's become a habitual in many cases, just kind of a crutch. So I would encourage anybody that's listening, really take a hard look at your alcohol consumption. And I can tell you, Robynne, I haven't been drinking for probably a good 20 years and I've was never an alcoholic, I just prefer the way I feel when I'm not drinking at all. And I think it's a great example that I'm setting too for my three young kids.
Dr. Robynne Chutkan:
Let me ask you, was that a sort of concerted decision to say, "Okay, I'm not going to drink anymore?", or was it just a gradual falling away of something that you felt didn't serve you?
Rip Esselstyn:
No, it's the latter. Just a gradual falling away of something that didn't serve me. And I've never enjoyed the taste of alcohol. I've never liked the taste of wine, beers, every once in a while a cold beer was nice, but I don't miss it in the least.
Dr. Robynne Chutkan:
It is though. I think you make an important point about the habit. It is a physiologically addictive thing. In addition to the emotional piece, so you feel like, "Oh, I've had a hard day, I need some alcohol." And celebrating, "I need some alcohol.", whatever it is. It is physiologically addictive in addition to that. And so, people can, and I love this book called This Naked Mind, Annie Grace, I don't know if you've read it or had her on, but-
Rip Esselstyn:
I've heard of it, yes.
Dr. Robynne Chutkan:
... She's phenomenal, yeah. Because she talks about it, she's somebody who was an alcoholic and is sober. But she talks about the physiological dependence, most people can power through that and after a few weeks they're over that, their body can adjust. But it is the emotional dependence and it is a belief, the subliminal belief and it's reinforced every day, all the time by all the messaging that life is less fun without alcohol, that you're not going to have a good time, you're not going to be able to celebrate or mourn or whatever it is. And she talks in the book about, I know we're supposed to be talking about my book, but it is a great book and I do always love to salute other people out there who I think are doing great work. She talks about making that decision on a daily basis, having to like, "Oh, should I drink, should I not drink?", versus making that one time decision to say, "Hey, this thing is making my life worse, not better." And once you make that decision, of course, I think there's probably a little bit more to it than that.
But yeah, these things are not, that we think of as fringe, like eating vegetables, not drinking, exercising a lot. What I want to say to people out there is, look at the people who are doing this, look at people, Rip, like his sister Jane, like his mother Anne, like his dad Essy. Look at people like Rich Roll who are living that life. There's a vibrancy. There's health and vibrancy and joy in that that I think is not a coincidence. I mean, maybe the Esselstyn clan are just a joyful group. Maybe you just have that joyful gene. There's some of that, but there's also, as I said on the back of Anna Jane's book, I want some of what they're having. There's a lot of dirt, sweat and veg going on in that family. And it's not a coincidence that I think people who are living this way are reaping certain benefits that all of us can reap if we live a little more that way.
Rip Esselstyn:
Yeah. No, I would try and sit with somebody different at every lunch. In this one lunch, I sat with four women, one of them was from DC and they were best friends, they decided to come to this retreat and they were all in their mid to late fifties. And every one of them had stopped alcohol within the last year or two. And they went around the table just remarking how their lives have been so vastly improved. But it's so hard in this culture where everywhere you turn, it's like, "Oh yeah, here's wine, here's beer, here's this, here's that." And it's just like eating this way, you have to go out of your way to make the right healthy choice.
Dr. Robynne Chutkan:
And find the people who support that. I love the story of them coming together and doing this fun thing as almost like you'd go on a spa trip, girls trip to come to Plant Stock. And it's like your kids and you know this, you have kids. Your kids absorb the behavior and values of the kids they spend a lot of time with. So we all know we want kids to be friends with these kids. Well, we have to think about that as adults too. Who do we want to rub off on us?
Rip Esselstyn:
Yeah. So, I want to talk a little bit more about your book here. In chapter eight, you talk about building up your body, growing a good gut garden and what we want to do with that, with food and exercise. Chapter nine is about securing defenses, let's make sure that we don't dismantle all these defenses that we have, which we've talked about, which we're doing, unwittingly we're doing it with all the antibiotics and the birth control pills and the alcohol and the sweeteners. Chapter 10 is mastering your mind. I'd love for us to talk a little bit about mastering your mind and changing our environment, which is chapter 11. Because I think these are really important things that most people listening or a lot of people listening would get a great value out of.
Dr. Robynne Chutkan:
I'm so glad you mentioned those Rip, because as a gastroenterologist, I'm very focused on the stomach acid and the gut lining and the bacteria and the mucus production in the gut. And I'll tell you, the research in this area is astounding. And so again, pointing out great books, Why We Sleep, Matthew Walker, Sleep Better. Sean Stevenson. When you look at the data, the sleep data... And just to put it in perspective, if we go seven days without food, we'll be pretty hangry. We'll be hungry and angry, but we'll eat some food and we'll be fine. If we go seven days without water, we'll be really dehydrated and our kidneys may even start to be affected. If we go seven days without sleep, we're never recovering from that. That's why the Guinness Book of our Records doesn't take those, how long can you go without sleep records anymore because they're so destructive to our health.
Seven days without sleep, your risk for heart disease will have skyrocketed. If you're a man, your testosterone levels would've fallen precipitously. Your risk for stroke, your body just starts to break down. So sleep is a elixir that reboots our computer system.
And in terms of immune function, the data from COVID... Two things I want to tell people, but one is that, the study shows that chronic sleep deprivation, people are getting less than six hours a night linked to a 76% higher likelihood of becoming... Because again, lots of us are exposed to viruses, but the question is, do we get infected? And if we get infected, how sick do we get? So it's not exposure that is the main thing here. Exposure to some extent is inevitable, as we talked about with these things being ubiquitous. But illness and debility and death are not inevitable.
So in this study, it was 76% increase risk, for every additional hour of sleep people got the risk dropped by 12%. We know that vaccines are less effective in people who are sleep deprived. We know that, we've seen that with these recent round of COVID vaccines, that the vaccines can be as much as 50% less effective if you are sleep deprived in the two days before you get the vaccine. So we know sleep is essential. We know that in terms of recruiting T-cells as part of the immune response, that we just don't get the same level of T-cell recruitment when we're sleep deprived. Stress, I can tell you-
Rip Esselstyn:
Well, you also mention how sunlight energizes those T-cells.
Dr. Robynne Chutkan:
... Absolutely. And sunrise also, when we wake up in the morning and we open our shades or the sunlight comes in, the sunlight causes a melatonin levels to fall, we're awake. And at night when it gets dark, the melatonin rises. So the sunlight is an important part of modulating that sleep cycle. The stressing is another one. And we see the physical manifestations of stress, of acute stress. If a snake all of a sudden slurred it into the room behind me, I would get pretty stressed out. So my blood pressure would go up, my heart rate would go up, my respiratory rate would go up, the hair on my body would stand on end. And all of these physiological changes would be manifest in my body as a result of some frightening thing like seeing the snake.
But it's chronic stress that's a problem. So that acute stress is the fight or flight, your adrenaline, noradrenaline coursing through your body. It's getting ready to help you do something, like run out of the room from the snake. But what's happening is that we're having those high levels of adrenaline, noradrenaline coursing through our body chronically as a result of all the stress in our lives. Stress about our jobs, about our kids, about our livelihood, about what do we want to be when we grow up, all the different things that are constantly percolating in our mind that cause us stress. And that kind of chronic stress doesn't have a survival advantage, it has exactly the opposite. And it is ruined us for our immune system. So we know that stress can actually increase levels of more pathogenic bacteria by a thousand fold in a few hours.
And that's why, think of college students at exam time. They are stressed out, they're sleep deprived and they're like eating poorly. And they get sick. They come down with a flu, a cold, pneumonia, mono, you name it. So, it's an experiment right there. So, the contribution of those things and then also the correlation with those things between the gut, with gut and sleep, because of course as I mentioned, serotonin, the feel good hormone is made in the gut, it's a precursor for melatonin, the sleep hormone, you start to see the connection. There's a Gut-Brain Axis via the Vagus Nerve. And then of course, all the connection too with stress.
And stress is one of the biggest contributors to dysbiosis, to a messed up microbiome, can hugely affect what's going on with a microbiome. So this is like, it's like a manual for your body with a gut centric view. And this book was hard to write, Rip. It was really tough, because unlike the other three books that I literally could have just regurgitated out in my sleep, I'd been a gastroenterologist for decades, I know this stuff inside and out. This was a new virus, the science was changing by the hour. I mean, I would read four articles in the morning, by the evening seven new articles would've come out that I needed to read to process all of this.
But what we know, the virus is novel, but the science is not novel, the science is not new. We know about the science of the microbiome, we know about postviral syndromes, we know about viral resiliency from polio, from the Spanish Flu epidemic. And so, once we kind of got through the chaos of like, "Oh my goodness, what is happening?", and were able to regain some sort of balance, we were able to, I think all of us in the medical and the scientific community to say, "Wait a second, we actually know a lot about this and a lot about what to do."
And I really enjoyed historically reading a lot about polio and Spanish Flu epidemic. One of the amazing things about the Spanish Flu epidemic is this whole concept of the open air factor, the OAF. So what they saw is that often the officers during the Spanish Flu epidemic a 100 years ago would be put inside the hospital to recuperate and the enlisted men were just put on cots outside and they noticed a huge difference in mortality. In some studies, as big a difference as 40% mortality for the officers in the hospital and 13% for the enlisted men outside. And so, this open air factor is defined as a germicidal constituent in air that basically is harmful to toxins, to pathogens, to bacteria.
And we've seen glimmers of it with this whole idea of forest bathing, what the Japanese call "shinrin-yoku" and you walk through the forest and you breathe and you listen and the sights and the sounds. And in that study, with the forest bathing, people who were taken out into the forest versus a Tokyo suburb, they found markers for heart disease decreased, blood pressure improved, feelings of wellbeing improved, but we know it has an antiviral effect too. So not only does being outside decrease viral transmission, it also improves outcome from viruses. Now that might be hard if you get COVID like I did in January in DC right in the middle of a snowstorm. But in terms of our resiliency of remembering that in addition to the food we're eating and getting sleep and trying not to be so stressed, getting outside, just walking outside in air, in addition to the sunlight, the vitamin D, this whole concept of the open air factor is really important.And I give some great suggestions how to do that from an organization called Forestry England for how to walk through, it doesn't have to be, I'm lucky to be surrounded by Rock Creek Park where I live in DC, but you could be in an urban area and how to walk through a city in a way that you're going to derive some benefit.
Rip Esselstyn:
And hug trees while you're doing it? You mentioned hug trees.
Dr. Robynne Chutkan:
100%, hug some trees, for sure.
Rip Esselstyn:
So Robynne, okay. Wonderful stuff. You have your top 10 list-
Dr. Robynne Chutkan:
Yes.
Rip Esselstyn:
... that you have in the book. I think we should go through some of those. And I can tee you up if you want me to.
Dr. Robynne Chutkan:
Yeah, yeah. Sure. Tee me up. Because I know what they are, but I would get the order wrong.
Rip Esselstyn:
Yeah, yeah. So your number one on the list is, eat more vegetables. Enough said?
Dr. Robynne Chutkan:
Even if you are a vegan, eat more vegetables. Yeah.
Rip Esselstyn:
And I love the way you say, you don't care if it's raw, steamed, sauteed, blended up, just get them in.
Dr. Robynne Chutkan:
Get them in.
Rip Esselstyn:
Yeah. Pass on factory food is number two.
Dr. Robynne Chutkan:
Yeah, I think there's a lot of confusion about what a processed food is. So I like to make it really simple for people. There is, if you see lentils, you know where lentils came from. But there's no lentil chip tree or plant or bush, like apples versus apple sauce or corn on the cob versus they make tires, car tires from corn. So if something... And so people show me these bars all the time and I'm like, "Okay. Yeah, those ingredients look pretty good, but you could also just go eat some nuts and dates and stuff too." And not to say, there's tons of stuff I eat that is processed and is from a factory because it's convenient and I think it's still healthy. But you want to try and increase the amount of stuff coming out of the ground and minimize the amount of stuff coming from the factory.
Rip Esselstyn:
Well, and I couldn't agree with you more there. Literally when you look at the data that's been generated from the US Economic Council and you see that 60% of what we consume is classified as a processed/refined food, that's a very, very important top 10 list. Number two. You say include some ferments. And I have to say that ferment of food is something that I don't do hardly ever. How important is that?
Dr. Robynne Chutkan:
Yeah, again, it's one of those things, you eat tons of other plants, so I think you're fine with skipping some ferments. I like a sauerkraut that has a little apple in it. I'm not a kimchi fan, even though I like spicy stuff. But again, in somebody who's really trying to build up their microbiome, particularly after a round of antibiotics or they've been on PPIs for a few years, this can be really important. So we know that a tablespoon about, which is about 10 grams typically of something like sauerkraut can provide up to two dozen different bacterial strains plus all the post metabolites that they're making. It's like a living vitamin, and you're also getting the fiber from the cabbage. So I think the fermented category is really important for, again, your microbiome has been majorly disrupted and you're trying to rebuild and can be more effective than a probiotic for a lot of people.
Rip Esselstyn:
Right, right, right.
Dr. Robynne Chutkan:
But I think you're good. I think you're good. You definitely can get a pass on the ferments.
Rip Esselstyn:
Yeah, I mean, every once in a while I'll do some kimchi or something like that. And obviously I do enjoy tempe, I think which qualifies as one. We've already talked, I think pretty extensively about number four on your list, which is drink alcohol in moderation... Or not at all.
Dr. Robynne Chutkan:
Yeah.
Rip Esselstyn:
So number five is hydrate. And I think that a lot of Americans are chronically dehydrated. There you go. Including myself. And you even talk about how important it is for our mucus.
Dr. Robynne Chutkan:
Absolutely.
Rip Esselstyn:
So yeah, what do you recommend there with hydration?
Dr. Robynne Chutkan:
So mucus again is this crazy combination of glue and jello that traps pathogens like viruses and it traps other things too, pollen. But it traps it and then it doesn't just trap it and the celia you cough it out. It also has enzymes that are active in it that are actively degrading these viruses. So mucus is a really important host defense. When you're not well hydrated, your mucus becomes more like somebody with cystic fibrosis. So they have a genetic disease that makes their mucus have a lower water content and it's thicker and it's not able to be as effective. So dehydration can move us more in that direction or taking an antihistamine, something like that that dries up our mucus, can be really...
Dr. Robynne Chutkan:
Like that dries up our mucus can be really a sabotaging move for that host defensive mucus. You want the mucus to flow and there's some simple things you can do with the mucus and I give a bunch of examples in the book, but hydration is obviously not smoking, things like that, but hydration is a key for having healthier mucus that's able to serve you better.
Rip Esselstyn:
Yeah, I think that, let's see, 1, 2, 3, 4, 5.
Dr. Robynne Chutkan:
Let's not forget two with that too how do viruses once they're in our body, get out? Well, since of a really common way for them to get into our body is that we swallow them, we ingest them, they get out by being washed out. What helps move the products of digestion, including any viruses that are there from north to south, is just good old water. We know that fecal shedding and elimination of the viruses is an important root of elimination and you're going to be much more efficient at that if you're well-hydrated.
Rip Esselstyn:
Nice. Number six is avoid unnecessary medications. I feel like we've talked about this, but I'd love for you to talk a little bit more specifically about antibiotics because I feel like they are very much, and I'm using this term carefully, abused, and yeah, before I let you answer, but you even talk like about how antibiotic-resistant infections now kill more people per year than all murders and all car accidents combined. That blew my mind when I saw that.
Dr. Robynne Chutkan:
Crazy, yeah. It's crazy.
Rip Esselstyn:
I didn't know this was that much of an issue.
Dr. Robynne Chutkan:
It's an issue for society because if we're not more judicious with these antibiotics, we're going to get to the point where all the bugs are resistant superbugs, and we're going to be plunged back into the dark ages 100 years ago when we had no antibiotics. We're rapidly heading there, but they're also a danger for the individual because they cause dysbiosis. The startling statistic is at about five days of a broad spectrum antibiotic, like the type you would use for a sinus infection or a bladder infection can remove up to a third of your gut bacteria and wishful thinking that you're just going to take a probiotic and you're good. That is not how it works, but there are also other problems. The nurse's health study earlier this year showed data from the health study showed that in middle-aged women, and they described this as woman in their 50s who were taking more than two months worth of antibiotics over a several year period, who cumulatively taken more than two months of antibiotics, that there was a significant decrease in global cognition.
That drop in cognition, that sort of global decline was equivalent to aging the brain three to four years. I think people are waking up to the idea that it's not just that antibiotics are bad to take because you're causing resistance superbugs in the environment, they're bad to take because they're disrupting your own health in terms of the antibiotics. I do give a list of those, what are the most important questions to ask if you've been prescribed an antibiotic, starting with, "Hey, is this antibiotic actually necessary?" You'd be surprised the amount of times that that prescribing is a gray zone and the doctor's like, "Ah, actually it's not, Would you prefer not to take it? That's fine." You want to ask that question. Then I also go through, you know what to do if you have to take an antibiotic and the mushroom tea and all the other things that you can do, the ferments, et cetera, to help build up your microbiome.
Rip Esselstyn:
Yeah, yeah. Beautiful. We also have talked about this, but I just want to give you another opportunity to circle back on it and that's sleep. I think you mentioned that, I mean, it seems like most people are getting, adults it seems like less than seven and certainly less than six with all the screen time here, but you have a fantastic chapter. I believe it's under mastering your mind about getting good sleep, and you have 28 different bullet points that you ask people to really look at and examine. I went through each one of those and I got to tell you, Robynne, I mean I did about 20 of them and I was so like, "Oh yeah, I'm nailing that one. Nailing that one, nailing that one. I can, okay, I'm going to improve on that one," but this to me was really valuable information.
Dr. Robynne Chutkan:
I'll tell you, Rip, when I turned in the first draft of the book, the sleep chapter was 61 pages and my team at Penguin Random House at Avery, they were like, "Yeah, Matthew Walker wrote that book. We need to dial down." I mean, I was so juiced about the sleep. I mean it was, the sleep chapter was a book so I had to condense it, but what I really did was I took a lot of stuff out of the sleep chapter and put it in the plan and I divided it up as you saw by this is environment, body, mind, supplements because I'm like, people are not sleeping. They're not realizing the connection between the gut and sleep and sleep and the immune system, the gut and the immune system. I've got to connect the dots for people.
I'm really proud of the prescriptive part of the sleep one in there. I tell you of all the things in the book, it's the one I struggle the most with is sleep. I feel it. I mean, talk about feeling hungover when you are sleep deprived to the point now I won't take a red eye. I needed to go to Vegas for a meeting and the folks who wanted me to come were saying I had to get back to DC and they were like, "Oh, we can put you on the red eye." I was like, "Absolutely not. I'm not missing a night of sleep."
Rip Esselstyn:
Yeah, and what happens is you take that red eye and you get maybe three and a half hours of sleep. You don't recover from that for probably two or three days, if at all.
Dr. Robynne Chutkan:
If at all is what we see is you can't really pay down a sleep debt, is it affects you. Yeah.
Rip Esselstyn:
What are your personal challenges when it comes to sleep? Why is that so hard for you?
Dr. Robynne Chutkan:
I showed turned around the screen and I'll just turn it around quickly for people here that I live surrounded by this amazing Rock Creek Forest and it's absolutely beautiful and our bedroom upstairs is all glass and we have the forest. When we built this house about four years ago, I was like, "Oh, I don't want any window treatments, I just want to wake up with the sun," and that's all fine because it's all forest and there's no lights out there, but we have wonderful neighbors on one side who a couple years ago put up some lights outside that they keep on all the time. They have these small dogs. I've just been hoping that maybe they'll listen to this and they'll turn them down, but I feel like it's kind of an imposition for me to ask them to say, "Could you turn those lights off?"
They're like holiday lights really bright outside. And so they create so much light pollution, they have them on all the time. Now it's daylight. I mean, it's not quite daylight but it's very light in our room, and I haven't wanted to do window treatments to get blackout shade, but yeah, we're getting blackout shades. We're getting blackout. They're on the way because I feel so lucky to live ... It's like living in a snow globe. I live in this house and the bedroom is just surrounded by forest and there's nobody that ... I mean, if I don't have clothes on the deer and the owls can see me, but there's nobody, it's just forest, so we haven't needed any window treatments for privacy, but I'll tell you, I listened, I think I first listened to Matt Walkers Why We Sleep. I first listened to him I think on Rich's podcast and then I might have watched his masterclass.
I read his book and I was like, "Yeah, we got to do something," because that is really the ... I mean, I also am aware, particularly when I was writing this book, I jump out of bed and have my notebook and I would turn the light on of course and wake my husband up and write something down. I am one of those people who with sleep, I'll start meditating and something will come up and some of my best thoughts come up while I'm sleeping for sure. I figured out how to deal with that and I love it because I actually get these great ideas and I'll write them down and be able to go back to sleep. There is a certain amount of worry perseveration, you're thinking about something you can't turn the computer and your head off. I'm pretty good at that stuff now, so I would say right now it's really the light and I got to make it dark.
Rip Esselstyn:
Can I make a suggestion?
Dr. Robynne Chutkan:
Yes.
Rip Esselstyn:
I know that and-
Dr. Robynne Chutkan:
An eye mask?
Rip Esselstyn:
Well certainly, and there's lots out there and some of them really do a phenomenal job at blocking out the light. I did. I've tried them. I don't usually like anything on my face, but you can get used to it kind of like a seatbelt getting in the car. What about going and having just a nice heart-to-heart with your neighbor?
Dr. Robynne Chutkan:
With the neighbors? Yeah.
Rip Esselstyn:
I mean, I know it's a little uncomfortable, but I think if you were to couch it in the right way, you might be able to get them to turn it off maybe after 10:30 or 11:00 PM might be something.
Dr. Robynne Chutkan:
It's a good idea. They're lovely people and I think I could have the conversation in a way for them not to feel pressured, but just to say, "Hey, we're about to get these blinds, but I just want to ..." Yeah, no it's a good idea. Cause I can't sleep for the eye mask thing on my face either.
Rip Esselstyn:
Okay. Yeah, but I know what you mean. I used to live in an apartment when I was at college and there was a bright light and even with the shades down it came through and it was the worst year of my life as far as just sleep and stuff like that, so I feel your pain there. Let's move on, so the next is exercise. At the very, very top of this we talked about how you know love to run and you were doing the triathlons and squash and yoga. I'm very active. What have you shown as far as how important is exercise for us to be build up our immune system and our gut?
Dr. Robynne Chutkan:
The studies show it's the most important non-pharmaceutical intervention for our immune system. If people might have seen the New York Times article from early October, mid-October, maybe second week in October, I think it might've been October 14th that said here are four tried and true ways to boost your immune system. When they say boost, they don't mean make it overactive, they mean to optimize it. Exercise was the number one thing. Exercise was the number one thing. The study they quote showed that people who are exercising five days a week for ideally at least 30 minutes a day have a 43% lower likelihood of coming down with viral respiratory tract infection. That's just one of dozens of different studies that we have out there, so again, the most important non-pharmaceutical modification of the immune system is exercise.
I posted it on social media and somebody asked, "Well, how much and blah blah blah," and I was like, "Look, ideally, 30 minutes, five days a week minimum of vigorous exercise enough to get your heart rate up 20% or more," but even raking leaves outside, even going for a walk where your heart rate isn't necessarily 20% above your baseline can make a difference. It's like colon cancer screening, some is better than none. There are definitely types of colon cancer screening that are better. Even the worst kind is better than no screening at all. I think the same is true for exercise. Whatever you like to do, if you're doing something, you're moving your body. The really fascinating thing, Rip, is that even in people who have obesity, which we know is a major risk factor for poor outcome from viral infections, if they are exercising regularly, even if they are not losing weight, we know that they are improving their resiliency. That's a big one.
Let me just say I do all of these things. I'm a marathon runner, I yoga, squash, tennis. I'm not particularly good at any of them. I remember when I ran my first Marine Corps marathon back in 1998 and you know how parents are. My mom was like, "Did you win?" I'm like, "Um, I finished."
Rip Esselstyn:
Did you make it to Boston?
Dr. Robynne Chutkan:
No. Yeah, right. I'm Jamaican so I'm supposed to be fast, but I'm not fast. I can go far, but I'm slow. I feel so grateful to be able to be out there. Yeah. Whether I'm walking on the trails, I'm running, I'm lifting weights, whatever I'm doing, I mean, it really is my moment of gratitude of I can do this. My body still works well enough for me able to do this.
Rip Esselstyn:
You have a quote in your book, "It's just like there's no bad veggies, there's no bad exercise," which ...
Dr. Robynne Chutkan:
I believe it.
Rip Esselstyn:
... Which I adore. Everybody, find something that resonates with you and move that body. We already did talk about this one as well and you mentioned it with that study with the war, but get outside. I feel like not enough people get outside these days. I was just looking at a study, Robynne, that came from the Kaiser Permanent Day Family study and it showed that of our America youth today, the average American youth is now in front of a screen seven and a half hours every day. Guess how many minutes they're outside playing a day? Seven. Seven minutes. Seven minutes.
Dr. Robynne Chutkan:
Wow. Seven and a half hours in front ... Yeah.
Rip Esselstyn:
Seven and a half and seven minutes. What a disparity there.
Dr. Robynne Chutkan:
Yeah, I mean there's a term for it. Nature deficit disorder, it's a real thing. I mean, it's a fancy way of saying this is what happens when kids are not outside. Physical health, mental health breaks down, everything.
Rip Esselstyn:
Then number 10 on your list is something that I really want to do more of and I need to carve out some time for it, and is get quiet.
Dr. Robynne Chutkan:
That's the hardest one.
Rip Esselstyn:
What's with getting quiet, why is that something that we should do?
Dr. Robynne Chutkan:
Yeah, it's just really learning to activate your parasympathetic nervous system. In terms of the stress, sympathetic nervous system, fight or flight revs you up, parasympathetic quiets you down. There are different ways to get to it with breath, et cetera, but just getting quiet physically, mentally, emotionally, all of that is a good way to trigger that parasympathetic nervous system. Rip, you're a high energy guy, I've seen you in person in action. I mean you're like, "Yeah, let's run 20 miles. Let's do ..." That stuff is super important. For you, you probably don't need a lot of time. We're probably talking about five minutes, it could be ... For me, it's often when I wake up in the morning and my husband's like, "Aren't you getting out of bed?" I'm like, "I'm meditating," but I'm just quietly, calmly thinking about stuff. For me, it's often in the morning before I get out of bed or when I get into bed before I fall asleep. It doesn't necessarily have to be in the middle of the day. You have to go sit somewhere. It can be at one of those convenient times too.
Rip Esselstyn:
Yeah. What are your ride or die guidelines?
Dr. Robynne Chutkan:
Yeah, dirt, sweat, veg, baby. That's it. I mean, if I were trying to be more inclusive, I would say dirt, sweat, veg, sleep, water, but dirt, sweat, veg. I got to get me some nature, I got to get sweaty and I have got to eat some vegetables and I don't get really complicated about what that looks like. Did I lift weights at Petworth studio, past CrossFit studio? Did I do yoga? Did I run? How fast, how far? Was I actually in the woods versus on the edge of the woods? How many veg? I just try and do those three things. It was funny, in medical school I had this thing, I don't know how I came up with it, but ut was, I don't even think I consciously came up with it, but it was my three things. I had to have at least two out of three every day for me to feel like, "Okay, I'm good."
The three things were, I had to get a little work done, as in actual schoolwork. I had to eat and I had to get some exercise and eat right was, there wasn't a lot of rules around it, but I knew what that was. That meant if I was doing a shift in the emergency room as a student, I wasn't eating Starburst for my dinner, but I was just not eating too much junk was basically it. Getting some exercise and doing a little bit of work. Again, if I did a little bit of work and I got some exercise and I ate a bunch of junk, it was okay. Or if I didn't eat a lot of junk and I, but I didn't get exercise, but I got some work, it was okay, but when I wasn't getting at least two out of the three, I just felt like I'm not feeling so good. Because I like to keep the work steady so that it's not, "Oh my goodness, it's the exam and I have no idea what's been going on." I like to feel like not panicked. Encourage people, figure out what your ride or die, what's your three things that you feel like are your things? What are your three things, Rip?
Rip Esselstyn:
I mean, that I need to do every day?
Dr. Robynne Chutkan:
Well, I'm going to need to do, but you feel good. The three things that you feel like you need - pretty important things that, Yeah,
Rip Esselstyn:
Yeah. Oh my gosh, so it's very easy for me. It is get in a workout. Usually it's first thing, it allows me to make get on top of the day. Then it's always eating plant strong, so three meals a day that are plant strong. Then for me, it's family time. One of the things that we've started to do, and I've talked about this on the podcast is, we've really made a concerted effort to have dinner around the dinner table. That just totally feeds my soul. I love every member of our family being able to get some talking time. We go around the table and we do rows and thorn, so what was the greatest part of your day and what was the hardest part of your day? It's just become a great little daily tradition that we've started and we started it six months ago.
Dr. Robynne Chutkan:
That's wonderful. No, I mean, again, this stuff matters. It's not just that you feel it and your kids feel it. We have scientific data showing how important this is showing in terms of resiliency for kids, lower levels of mental health issues, fewer infections. I mean, it's really powerful stuff. Yeah, that's great. Yours are then dirt, sweat, fam. I'm dirt, sweat veg, you're dirt, sweat, fam. You may even be fam, dirt, sweat.
Rip Esselstyn:
I think you're right.
Dr. Robynne Chutkan:
Yeah. Beautiful.
Rip Esselstyn:
I love reading people's acknowledgements and I read your acknowledgement in the Anti-Viral Gut, and I love the way your husband, Eric, basically gave you permission or asked you to do what you love, run in the woods and write books. Let me look at this. This is your fourth book, right?
Dr. Robynne Chutkan:
Yeah.
Rip Esselstyn:
Fourth book, The Anti-Viral Gut. In reading that acknowledgement, I realize what a lift it was. How many people were involved in bringing this out into the universe. This to me is especially where we are now in 2022, kind of coming off of COVID and knowing that unfortunately, because of how we are living now in this world, there's going to be more and more of these kind of viruses coming our way. I think that literally everybody should grab a copy, read this and do everything you can to protect yourselves from the next one that's headed our way, or the ones that are just out there.
Dr. Robynne Chutkan:
Yeah, the one's that are just not going away.
Rip Esselstyn:
Yeah, and I feel like I followed almost all of your protocols here in this book. I feel like, I can't even remember in 10 years how many times I've been sick. I came down with COVID. I mean, I got a bashing headache for about three days and then I was like, fine. You go, and in the book you talk about this long haul that is very, to me, oh that is so scary and how it predominantly affects women and then there's six different kind of attributes also that help increase your likelihood of that. I don't know if we want to continue to, but-
Dr. Robynne Chutkan:
Well, I'll say is that I have great empathy for anybody who comes down with this. Everything that I say, I mean, nothing is about blaming anybody for what has befallen them. It's all about empowering them to improve from it, but just in the last month we've had two really important studies that show that preexisting illness is a main risk factor for long health symptoms in children and in adults. That, for example, a lot of the mental health symptoms that we've seen with long COVID, again, if they're built on a platform of preexisting illness. The way to not have long COVID is to COVID at all for sure, but the next best thing is to make sure that your foundation, both your physical and your mental health is as good as it can be. That's something that we can be working towards all the time. With simple things like what you described, the beautiful sitting down together at a dinner table to eat with your family or with friends, with simple, inexpensive things, going outside, breathing, these things. Sometimes we need complicated medications, but most of the time we don't to really put these things into effect
Rip Esselstyn:
With the fact of the matter is, Robynne, I know maybe a handful of people in my life that haven't come down with COVID, literally one handful. I think most people have come across it. I think if you're, unless you're hiding at home, if you're out there living, you've probably exposed yourself to it. Again, to me, following the protocols that you suggest in The Anti-Viral Gut is just, it's so important. The other thing I want to say in reading your acknowledgement, and I hope you're keeping your promise now to your daughter, Sidney, is to catch up on movie nights, because you had to skip a lot of those.
Dr. Robynne Chutkan:
Oh yeah. I mean, still in my family they tease me because they're like, "You only like weird foreign films where everyone dies." They want to watch whatever the popular stuff is. I like want to watch something in Norwegian with subtitles where set on an island and it's all gloom and doom. I think I have slightly different tastes, but I've definitely, we found some good stuff that we all watch together and yeah, it's been great just having a little more time for that. For sure.
Rip Esselstyn:
Do you have a-
Dr. Robynne Chutkan:
I have to say, Rip, just to, it is really ... We have a couple doctors in the family like in your family. My dad who's, I think, around your dad's age, if not exactly. My dad's born in nineteen '39, '35, sorry, my mom's '39, so he's been around a while. He's a retired surgeon like your dad, and my brother's also a spine surgeon and I'm a gastroenterologist.
To be able to share something, to feel like you have something valuable that can help people and you get a chance to put it out in the world. I'm really grateful to my team at Penguin House at Avery. I'm really grateful to you and other folks have had me on the show because I get a megaphone. The book is one, but really being on the podcast is another, and to really, to get people excited about what they can do that's easy, that's inexpensive, that you don't have to do all of it, but what can you do to be healthier? That is an incredible privilege and something that makes me super excited and ...
Rip Esselstyn:
Yeah. Well-
Dr. Robynne Chutkan:
... Happy about.
Rip Esselstyn:
Yes. Well, well-deserved and again, when does this officially launch out into the world?
Dr. Robynne Chutkan:
November 1st.
Rip Esselstyn:
November 1st, 2022. It's a good day.
Dr. Robynne Chutkan:
It's coming right up.
Rip Esselstyn:
It is. Robynne, before we leave, I have one last question for you.
Dr. Robynne Chutkan:
Okay.
Rip Esselstyn:
Why is your name spelled the way it is? It's a very unique spelling of Robynne.
Dr. Robynne Chutkan:
Rip, my parents are very normal, down to earth people. It is a mystery of my life, particularly with a last name like Chutkan can that my dad is Indian and his family migrated from India. Well, didn't migrate, my grandfather was taken from India by the British and brought to Jamaica to work on the sugar cane plantation in a system of indentured labor that proceeded slavery, so migrated is a very kind and generous term, but that name was change was probably Chutkani, and it was changed to Chutkan, C-H-U-T-K-A-N. That name is also tricky. Then Robynne, how about just an R-O-B-I-N? I have no idea. If you met my parents, you'd be like, "These are not the kind of people to come up with this weird spelling," so it's like, okay, the last name is hard and the first name, but I'll tell you what, the only good thing about it is I'm easy to find, right? There's nobody else with this weird spelling and combination of names. If people even get in the vicinity, I'm grateful if people are like Robbie Ann, Robynne, like I'm grateful if they come close.
Rip Esselstyn:
For everybody listening that can't see, if you're not though watching this on YouTube, her name is spelled R-O-B-Y-N-N-E.
Dr. Robynne Chutkan:
Why? Why is right.
Rip Esselstyn:
Why not? Why not?
Dr. Robynne Chutkan:
Such a good question to end on.
Rip Esselstyn:
Yeah. Yeah. All right. Hey Robynne, it's been an absolute pleasure. Wow. You are such an absolute treasure trove of information that I really, I need to have you back on sometime soon because I feel like we just started to make a dent on all the information that's in this book.
Dr. Robynne Chutkan:
Let's do it in person. I'll come out to Austin. I've been looking for an excuse to come. I was in Dallas two weeks ago. I've been to other parts of Texas. I've never been to Austin. I hear it's so fantastic.
Rip Esselstyn:
It is.
Dr. Robynne Chutkan:
I know Eric would love to come. Let's regroup in Austin.
Rip Esselstyn:
All right. I would love that. All right, Robynne, enjoy DC and all the best with the book.
Dr. Robynne Chutkan:
Thank you so much. Thanks so much for having me on.
Rip Esselstyn:
Robynne's new book, The Anti-Viral Gut is out now, and we'll be sure to put a link in the show notes of this episode. It really is a manual for your body with a gut-centric view, and by focusing on both your internal and external health and environment, you can boost your immunity, improve your overall health and well-being, and minimize the risk for serious viruses. The absolute best way of doing this by keeping it, you know it, plant strong. Thanks so much for listening.
The Plant Strong podcast team includes Carrie Barrett, Laurie Kortowich, Ami Mackey, Patrick Gavin, and Wade Clark. This season is dedicated to all of those courageous truth seekers who weren't afraid to look through the lens with clear vision and hold firm to a higher truth. Most notably, my parents, Dr. Caldwell B. Esselstyn Jr. and Ann Crile Esselstyn. Thanks for listening.
