The Surprising Role of the Microbiome in Health and Disease
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Coming up on this episode of The Doctor's Pharmacy, our gut and our brain are connected. There's a whole hard wiring of nervous system. The gut even has this independent nervous system that actually is like a second brain. You know, we often say people with irritable bowel are emotional or anxious or have maladaptive emotional coping mechanisms, but it turns out the irritable bowel actually can cause an irritable brain and lead to anxiety and all these emotional issues. So it's bidirectional.

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Now, a key principle of functional medicine is looking at the gut and how it impacts the entire body. But ultimately, there's a bi-directional relationship between the gut and the body. And things like stress, sleep, exercise can affect the microbiome in the gut at the same time and imbalance ultimately.

gut can affect mental health, sleep, and much more. In today's episode, we feature clips from five different conversations from the doctor's pharmacy about why it's so important to pay attention and heal the gut while also making healthy lifestyle choices to support the entire body. I talked with Dr. Elizabeth Bohem about the Functional Medicine 5R program to heal the gut and Shawn Stevenson about the importance of a healthy gut for sleep and everything in between, including stress management, gut microbes, and daily exercise. So let's jump in.

As a functional medicine doctor for the last 30 years, and you've been doing this almost as long, the results you get from focusing on the gut with so many conditions, whether it's autoimmune or whether it's allergic, whether it's digestive, whether it's your skin issues like acne or eczema, whether it's your mood, whether it's weight metabolism, whether it's migraines, whether it's...

Alzheimer's, I mean, autism, ADD. It's just amazing when you start to focus on it. So let's break down the five-hour program for everybody. So we got the remove. So what are we looking at? We're removing- Removing unhealthy foods or inflammatory foods for that person. So they can be food sensitivities and gluten and dairy are the big ones. Food allergies and sensitivities, yeah. Right.

And then we're removing- Processed food and junk food, right? Oh yeah, that's for sure. And sugars and excess sugar, which is feeding the wrong bacteria. And then we're removing-

The unhealthy bugs or yeasts or viruses. You might have bacterial overgrowth, yeast overgrowth, a parasite. Yep. You know, I was on the Red Table Talk and Jada and her son both had parasites and they both had gut issues for a long, long time. Right. And they thought it was just how they were. Yeah. But with, you know, short little course of treatment, they were both...

I've never felt better. Right. And all the other symptoms. Because now you're actually absorbing the nutrients you're eating, which just helps the body heal. Yeah. So, so then, so you, you remove. Then we replace. But you might also remove things like heavy metals or stress or toxic people in your life or whatever's giving you a stomach problem. Right, right, right. Replace means just to replace some of those digestive enzymes if needed. Re-inoculate. So the replace also could be like,

prebiotics, right? So putting in the fibers to feed the gut and to actually maybe use hydrochloric acid sometimes for people who aren't digesting their food as they get older. Yeah. And to help get them off of the acid blockers, which we know are creating a lot of problems because we need that acid in our stomach to digest our food. Okay. Let's take a little detour. So you just mentioned acid blockers. Uh-huh.

These are among the most prevalent drugs prescribed today in America. And statins, I think. When I was in medical school in the 80s, we just had those drugs come on the market. The drug reps used to come to us and say, these are very powerful drugs.

Never use them for more than six weeks because they block stomach acid and don't cause significant problems if you do that long term. Right. You can cure an ulcer with it. You can fix an acute problem, but never use this. Now people are on this for decades. Yes. And the...

side effect, which is listed in the manuals that we get as doctors, is that it causes irritable bowel syndrome. So you end up fixing the heartburn, but you get irritable bowel and bloating and bacterial overgrowth and all these problems. Right, because you need the acid in your stomach. And when you block that acid, then there can be an overgrowth of bacteria where there's not supposed to be, and that can cause all those slew of problems.

- Change the pH, you get more yeast issues and all this stuff. - And then you're not absorbing your minerals so you can get osteoporosis and you're not absorbing your B12 so you can get fatigue and dementia, right? It just goes on and on and on. - Yeah, it'll absorb zinc and magnesium, minerals, calcium, it causes osteoporosis, pneumonia, it causes, you know, irritable bowel. - It goes on and on, right? And it takes some work sometimes. When people have been on an acid blocker for a long time,

It takes some work for us to help wean them off because their body has gotten pretty used to it. They start to get, their bodies, their body wants to make acid. So it's working against the medicine. So when you wean them down, sometimes they get more acid production. It's called rebound. So you actually, it's like, and it's sort of a trick. Like you get off it, but it makes you worse. So you feel like you have to get back on it. But it's actually not.

True. And you can actually get off it. Absolutely. So we do that all the time. We do it all the time. So re-inoculate, giving all the good prebiotics and probiotics, the good bacteria and all the things that feed the good bacteria. And then the fourth R is repair. How do you know what probiotics to take? Oh, that's a great question.

I want to know, what are you prescribed? Oh my goodness, that goes on and on. We could talk about that for the next hour. Yes, it's true. Right? There's more and more probiotics on the market every day. And all have different roles and different functions. And we're just sort of, honestly, I think we've been doing this forever, but it feels to me like we're at the infancy of this understanding of how to use these in medicine. Yep. I mean, there's some great brands that I trust and I use all the time. But when somebody is...

doesn't maybe know what to do, I'll say, you know, get one, get go to a reputable place, reputable pharmacy or a good wellness store pharmacy and and get a probiotic, you know, try it,

If it makes you feel worse, then stop it, you know? Because there's some good bacteria that make people feel worse. Well, they have bacterial overgrowth. Exactly. You have bad bugs growing in there and you put the good bugs in there, they have a fight. Yep. And they cause lots of bloating. And so that means we just have to do more work before we can start it. Yeah. So...

So they got to re-inoculate and then you got the- And then repair. Yeah. And that's the fourth R. So that's things like, that's like giving good protein, good amino acids, which are the building blocks of protein sometimes- To repair. Yeah. To help repair that barrier, that coffee filter, right? We have to repair it with good

protein. And sometimes we'll use amino acids like glutamine that help repair it. We'll give more zinc, whether it's from food sources or as a supplement. Maybe we'll give some vitamin A, which also helps with healing that barrier. It helps with healing the endothelium in the gut

So those are things we will do to repair. And then rebalance, right? That's the fifth R, which is really focused on managing our stress and how we're reacting to the world. Because we know that when our parasympathetic nervous system is engaged, when that calming nervous system is engaged through meditation and yoga and breath work, that our body has the ability to heal. And it heals better when our body is at

I mean, yeah, you know, you just touched on something very powerful, which is that our, our gut and our brain are connected. There's a whole hard wiring of nervous system in our gut even has this independent nervous system that actually is like a second brain. Yeah. And, and so,

You know, we often say people with irritable bowel are emotional or anxious or have, you know, just maladaptive emotional coping mechanisms. But it turns out that the irritable bowel actually can cause an irritable brain and lead to anxiety and all these emotional issues. So it's bidirectional. And I think that's a great lever for helping people reset their gut. Absolutely. You know, I just want to share a story because I've been doing this for a long time. And of course, my...

I don't know what it is, curse or blessing, depending on how you look at it, is actually getting really sick and having to figure out what to do to fix myself. Yeah. And I've had a lot of gut issues over the years, which is why I really focused on this. The first was when I had mercury poisoning. And I tried everything. I did every functional medicine trick in the book back then, and it wasn't working. Right.

Right. Until I got the mercury out, which disrupts all your enzymes, it disrupts your gut, it causes leaky gut, it causes yeast overgrowth, it screws up the bacteria in your gut. Until I got rid of the mercury from my system, I couldn't get my gut straight. Yeah. Because it's impacting your immune system too, right? Right. And then many years later, I kind of got an issue which was triggered by

an antibiotic for a root canal that I had to take called clindamycin, which is known to cause C. diff, which is a terrible bacterial infection that kills like 30,000 people a year. Yeah. And I got that. Yeah. And I was so sick. I remember. And Liz would come over to my house and I was like, it was pretty bad. I'm like, we're all struggling to figure it out. Yeah. And I had mold in my house and all these other things, but I ended up having colitis and I had trachea.

I had tremendous leaky gut and I did my own stool test. And my friend, Patrick Hannaway, who worked for the stool test company for many years, my colleague at Cleveland Clinic, he and I looked at my stool test and we probably between the two of us seen like 20,000 stool tests. We're like, this is the worst one we've ever seen.

And everything was screwed up. And I had no good bacteria. I had low butyrate. I was not digesting. I had tons of inflammation. It was terrible. And I couldn't really fix it using a lot of the traditional things. And then I started to sort of work on a gut shake, which included a lot of the sort of 5R concepts, right? So I cleaned up my diet, obviously. I got rid of the bad bugs. But

But I used a combination of these polyphenols from the plants, pomegranate, cranberry, green tea. Also added glutamine. I added prebiotics, probiotics. I even added colostrum, which is to help regulate the immune system. And it was like a miracle. I went from full-blown colitis to normal in three weeks. And I've been great ever since. And it's just like, wow, this is something that people can actually do.

Stress is one of those things that is ubiquitous. We all experience it and learning how to deal with it is an important life skill, whether it's through meditation, yoga, hot and cold plunges, sleeps, whether it's massage, whether it's deep relational connection with somebody else, whatever it is that resets your nervous system. But many of us are just bombarded with chronic stress and it leads to changes in our health. And one of the ways it alters our health is through change in our microbiome.

uh and the microbiome literally is listening to your thoughts the bacteria know what you're thinking and they they actually change and when you are under chronic stress it changes the bacteria to be more toxic the bad ones grow the good ones die and you end up with more and more dysbiosis which has all these downstream consequences so we know that that you know people say they get

gut feeling, right? This is a real thing that my stomach's in butterflies or my stomach's in knots or my whatever, whatever the metaphors we use because the gut is directly connected to your nervous system. And there's more neurotransmitters in your gut than there is in your brain, right? Which is crazy when you think about it. And there's a whole separate nervous system called the enteric nervous system, which is the basically means the gut nervous system. And it communicates with your brain, but it's bidirectional.

So stress here will cause stress in your gut. The stress in your brain causes stress in your gut. Stress in your gut will cause stress in your brain. So we used to think irritable bowel syndrome was because people were neurotic and that was what was causing the problem. But actually we found out that the inflammation from the irritable bowel because of dysbiosis in the gut creates inflammation in the brain, which makes you anxious and depressed. So it's kind of a bidirectional system.

So stress will mess up your gut, but your gut can mess up your stress. You know what I mean? You kind of have to deal with all the things that disturb the gut, right? It's your diet, it's stress, it's sleep, it's exercise, it's the right environments. You're not exposed to toxins at an excess level. All of that is so important. And I think we're so bad in medicine at dealing with gut issues. It's just embarrassing. And unfortunately, conventional medicine,

Now they're told to eat more fiber or do a FODMAP diet if you have irritable bowel. Now they're treating bacterial overgrowth, but they just give you an antibiotic and they don't deal with anything else to restore the gut.

Or they give you acid blocking drugs for heartburn, which makes more problems downstream. And it's really a crime because we know so much about how to deal with these issues. I've written many, many blogs about irritable bowel and reflux and heartburn. Check them out. We'll link to them in the show notes. But the

The reality is that we now know so much about how to handle these problems in a much more effective way through diet and lifestyle and through dealing with looking for root causes and diagnostic tests that we just don't get in the traditional doctors.

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If you're an omnivore, it's different. If you're a vegan, it's different. So what is the right microbiome? That's really the question is how do you get a healthy microbiome? And I think, you know, we still haven't figured that out. You know, we know we can measure diversity, which is important, the complexity of the ecosystem. We can measure markers like short-chain fatty acids, inflammatory markers. We can look at what bugs are there, what are not there, what's growing, if there's parasites. All that is helpful. You know, what I find challenging about some of these programs

microbiome tests is they only look at the microbes. They don't look at the function of the gut. And as a functional medicine doctor, that's what I care about is what are these bacteria doing? For example, some kids I'll see who have autism, very, very low short chain fatty acids of, for example, butyrate.

which is anti-inflammatory, and very high levels of something called propionic acid, which is very inflammatory. And propionic acid has been shown in animal studies to increase autism and autism behavior. And if you look at breastfed kids versus bottle-fed kids, they have different short-chain fatty acids. The breastfed kids have high butyrate.

because their bacteria are being fed by the breast milk with the oligosaccharides that are in the breast milk. Basically, the oligosaccharides are prebiotic, right? This is a prebiotic made by the body for the bacteria for babies in breast milk. That's what it is. And if you take formula, there's no prebiotic oligosaccharides. And so instead of getting butyrate, these kids get high propionic acid.

That's why we see breastfeeding is so important correlated with better health outcomes and where maybe bottle feeding is leading to increases in propionic acid, which can have adverse consequences for cognitive function, for autism and learning difficulties, ADD and lots more. I think it's important to realize that our diet really matters and that

Prebiotics that are in our food really are key. Historically, if we were hunter-gatherers, we didn't have a choice. We had to eat whatever we could. We got root, a berry, some tree bark, or whatever. That's just what we had to do. That was more of a natural environment for them. It was, yes, if all we had was sugar, that's all we'd want to eat, we'd be really happy, but we'd get very sick.

But they had a wide variety of foods and a far more complex diet than we do. The whole variety of roots and berries and plant foods and lots of different kinds of animals. And also they'll eat the bone marrow. They'll eat all sorts of stuff. So really, really important to think about how do we get the right balance of things for us in a way that isn't going to be too onerous, but that's going to be designed to fertilize the right bugs and not grow the wrong bugs.

When you start thinking about how to take this approach of incorporating movement and exercise in your life,

you can get really amazing benefits. I'm just going to kind of go through them because they're just so profound. It actually unlocks the body's longevity switches, the regenerative and reparative systems that are built into our biology. It activates all the longevity switches that I talk about in the book, particularly the four that have to do with nutrient sensing pathways that are sort of met into everything else, insulin signaling.

mTOR, which is really important in terms of autophagy and cleaning up your cells, sirtuins, which are important in DNA repair, and also AMPK, which helps regulate blood sugar, insulin sensitivity, inflammation, and many other things. So it's pretty darn exciting. It also activates the body's antioxidant systems. It improves your cognitive function and your mood.

It supports, I mean, they found that just walking helps prevent dementia, which is pretty cool. It supports your microbiome. It reduces inflammation. It helps you produce more mitochondria and help them work better and be more efficient and have better function because mitochondria is where you make energy. And as you get older, you lose energy. So you want to boost that. It also keeps you strong and functional. You know, I just came back from skiing out in Switzerland and I had a really great time. It was a privilege to be able to go there.

And I was amazed. Like I was just skiing along like I was when I was 30 or 40. And I was probably going a little too fast, but you know, I like to do that. And, and, you know, I felt strong and able to do it. And it was keeping up with people half my age. So I think the body has the capacity at age to do this.

It also makes you happier and improves your mood and even improves your sex life, believe it or not. So what does the research say? And let's talk about some of the nitty gritty about how it works. If you really, you know, maybe you want to know about the science, maybe that'll motivate you. I probably doesn't motivate most people, but it kind of gets me all excited. I kind of like that. I'm a little weird, but it really, the research is just,

It's just unbelievable about exercise. When I started to dig into, you know, obviously you can look at exercise and anything and search on PubMed and learn about it. But I started to look at exercise and longevity and what it does. So we covered a little bit of this, but I want to sort of expand on it. It improves your telomeres, which are little caps at the end of your chromosomes that start to shorten as you get older and shorten your life.

It actually lengthens your telomeres by exercising. It protects your telomeres. It optimizes all these longevity switches like AMPK, which regulates blood sugar. People say, oh, I'm going to take metformin for longevity. Well, exercise is way better than metformin for regulating AMPK. It also activates sirtuins, which help DNA repair, reduce inflammation, and improve your blood sugar control, which are really important. It also improves

your cardiovascular and heart health, we all know it reduces the risk of heart attacks and strokes and improves your brain function and cognitive function. It also helps certain types of cancer. As I said, you know, we see the regulation of our biology through exercise being meted through all these mechanisms have to do with immunity and cancer prevention. So it's super great. And of course it extends your health span and your lifespan. I remember being in Sardinia and I

I mentioned this guy, I think before, but his name is Pietro. He was 95 years old and he was like a shepherd and he was just running up and down the mountains all day, five miles a day in this really rugged terrain. And he was bolt upright, you know, booming voice, clear eyes, you know, strong and, and mentally sharp. And I was like, wow, this guy's 95 years old. You know, most people are 95 in America barely can kind of walk across the street or get from there.

their bedroom to the bathroom. And here he is running up the mountain. So we have the ability to do that. And he exercised every day as a shepherd, not quote exercise, but that was his life. It's incredible for diabetes, for blood sugar control. I mean, just walking after dinner is a great way to keep your blood sugar down, helps you become more insulin sensitive. And very importantly, it helps you build muscle mass and function. Because as you get older...

You lose muscle. It's called sarcopenia, and that leads to all these hormonal and metabolic changes that accelerate aging and lower testosterone, high cortisol, the stress hormone, higher blood sugar, worsening cholesterol. I mean, just lower growth hormone and increased cortisol. Like I said, it's really bad news. So building muscle is really important, and that's clearly only done by exercise. So hopefully, listening to all this, you realize you can't afford not to move.

My basically philosophy is if you don't move, you won't. Literally, you'll be dead. So how can you actually incorporate more movement? What can you do without having to drag yourself to the gym? Now, I go to the gym sometimes, but I rather play. And I think there's a lot of options. And you can just do simple things like start with simple things, even five minutes a day. And if you don't have five minutes a day to do something, there's something wrong with your life. So you better...

at that. So, you know, for example, I figured out I couldn't do 10 push-ups when I was 50. So I started, I'm going to do push-ups. So I take a shower most days. So I basically would wait

Wait for the shower to heat up because I live in a barn and it's really tall and it takes a while for the hot water to get upstairs. And I would do push-ups. And I went from being able to not be able to do 10 to be able to do almost 100 push-ups without stopping. So we can train our bodies and it's really simple. Or maybe while your coffee is brewing, maybe do some stretching and yoga. Walk or...

bike instead of driving. In many countries, they do this. I just met this guy who was a CEO of a big company. He lived in Switzerland. He runs a $6 billion company. He rides his bike

straight up the hill or the mountains to work 2,000 feet elevation every day. And he's in incredible shape. He's 53 years old and his VO2 max, which is a measure of fitness, is that of an elite athlete and someone who's like half his age. So it's very impressive. You don't have to sort of, you know,

do something like that, but just, you know, parking further away in the parking lot, taking the stairs instead of the elevator, the escalator, just simple things to start moving. Also try a standing desk or a stability ball. If you're, you know, at a desk, you sit on a ball, it kind of helps you move and move your body and increase your core strength. I have a friend, Mike Roizen, who was at Cleveland Clinic with me, and he used to have a treadmill desk

He was on calls and working and working on his computer and walking all day long, which is impressive. Make your leisure time active time. So if you're watching TV or movie, maybe put a stationary bike in your house. I remember I worked in Idaho as a family doc and there was this patient that came in

And she lost like 100 pounds. I'm like, what happened to you? And she's like, well, I decided instead of sitting in front of the TV and eating all day, I would get a stationary bike and just ride the bike all day instead of eating. And she did. And she lost 100 pounds. So pretty impressive. Maybe also you can listen to podcasts and an audio book or do something like that when you're exercising or taking a walk. It just makes it more fun and motivating.

And also do it with somebody else. As my friend Rick Warren said, everybody needs a buddy. So it's important that if you maybe are having some trouble getting out there and doing stuff, find somebody else to do it with. It's much more fun for me to play tennis with somebody else or play basketball or go on a bike with somebody else and do it by myself. So I try to do it with friends and it's way more fun. Maybe pickleball is the latest craze. Join a pickleball league and go outside and just do it.

do fun stuff. So these are just a few examples of how to incorporate movement and exercise in your life and simple natural ways to do it. And it doesn't matter what you do. It's just a matter that you do it. So according to science, and particularly the science of longevity that I talk about in my book, Young Forever, go get a copy, please. It's really amazing. I like it a lot. It's one of my favorite books I've ever written. Maybe the favorite because I think I'm obviously more interested in this because I'm getting older. It's such a

an essential part of longevity and of health in general and just of enjoying life it's not about doing it now for some result later it makes you feel better now and we really can't afford not to exercise so start where you are build up slowly even 10 minutes a day of walking can help start strength training weight resistance training whatever whatever you want

Tell us how the microbiome in your gut affects your sleep and what you can do about it. Absolutely. So let's start with a basic component. And I know, again, these are going to be things people have heard about before, probably on your show. Yeah. But let's start with serotonin. Okay. So it's pretty well known. And by the way, there's more serotonin in your gut than there is in your brain. Exactly. Upwards of 80 to 90% of your body serotonin is actually located in your gut, produced by your enterochromaffin cells, by the way. All right. So- Those are special cells in your intestinal lining. Yes.

I'm just translating all the big words. I like that. We're like flipping places because I would do this for you. So here's what's so interesting is that serotonin, we talked about melatonin being important for our sleep and our circadian rhythm. Serotonin is a precursor or a seed to make melatonin. So already right off the bat, your gut environment, these cells in your gut

are helping to make this compound that's related to your sleep quality. And with melatonin, it's what I want to liken it to. It's like that manual gear shifter for you to go through your sleep cycles properly and to actually get recovered. You need melatonin to be produced. And we'll come back to that. So that's number one, serotonin. And you can't just take melatonin?

I'll answer that in a moment. That's tricky. So, well, I'll just tell you. So I looked around because some of our colleagues would feel that, and this was just a theory, that if you take supplemental melatonin, it's going to reduce your body's ability to produce it itself. And that's actually, I couldn't find that anywhere. There was no evidence of that. What I did find was

Taking supplemental melatonin, taking too much or too frequently can downregulate receptor sites for melatonin. So your body can still produce it, but the receptor sites that actually do something with the melatonin can get downregulated. So the key is there, but the lock isn't. Yeah. So we do need to be mindful of that and we can come back and talk about that. But here's the biggest probably aha moment hopefully of this episode is that it's not just serotonin that's producing the gut.

And so check this out. And I just came across this. I'm going to share this with you today. This was in the World Journal of Gastroenterology. Listen to this. They found that there's upwards of 400 times more melatonin in your gut than in your brain. Because you talked earlier about the pineal gland. That's what I was taught in school. It's produced by pineal gland in the story.

This study found that you can actually have a pinealectomy, which is a removal of your pineal gland, which I don't recommend, by the way, don't do that. It's like a frontal lobotomy, you know, go there. And you don't actually lose those levels of melatonin that's located in your gut.

So you're a gut brain and a brain brain. Exactly. And that's something really important to understand too. Your gut is really, it's often referred to as a second brain. We can call it the enteric nervous system. There's like 30 neurotransmitters, just like your brain. It's like a mass of nerve tissue. 60% of your immune system and most of the genes in your body as well. That vagus nerve. So UCLA researchers found that

the vagus nerve, which we thought was just kind of like the brain communicating more, telling the gut what to do. 90% of the communication from those nerve fibers from the vagus nerve to the brain is your belly, your gut telling your brain what to do in many ways. Totally nuts. And the other thing people should know is that when you're stressed, not only is your cortisol high and you lead to more fat accumulation, but it actually blocks your cells ability to burn calories.

Because the nerves from the vagus nerve help you metabolize your food, which is a relaxation nerve. It also has the effect of decreasing absorption of nutrients. So not only are you not absorbing, but your metabolism just slows down, which is amazing. It's just because of the nervous connection between your stress nerves and your relaxation nerves and all your gut function. So profound. But this is just getting out of that

isolation thinking. You know, this is what I was taught in school as well. It's like- Well, that's functional medicine. The body's a system. Yes. Everything is interconnected and it's a beautiful symphony if everything's working well. So Caltech researchers to kind of get to how does this all connect, they discovered that, and this was just, I mean, it's been around for years, but this is more of a recent like, okay, meta-analysis. Now we know that certain bacteria in the gut communicate with cells that produce these sleep-related hormones and neurotransmitters. Mm-hmm.

So your gut cascade, your microbiome has a huge impact on your sleep quality. And so now the question is, what do we do about it? How do we protect or support our microbiome? And that's one of the things that's going to help to improve your sleep quality. So let's just go through a couple. The biggest thing in my opinion is avoiding things that mess it up. All right. So one of those would be eating processed foods. So that

crazy amount of sugar has a tendency to feed pathogenic opportunistic bacteria. Right. So that's one thing, avoiding haphazard use of antibiotics. They have a place, but we shouldn't be using antibiotics every time you get the sniffles. Right. And that's literally what, when I was a kid, just give them some antibiotics. Right. We would even like, if my mom had some antibiotics, you know, just totally negligent. Yeah. Give them whatever's in the cupboard. Yeah.

Also, pesticides, herbicides, rodenticides. Petit metals. Yeah. These things, side literally means to kill, by the way. But these have a pretty, because they're meant to kill small things. Guess what your microbiome is made of, you know? And how many millions and millions of people are taking acid-blocked herbs?

Which also terribly disrupts your gut microbiome. Yeah. We're looking at that the wrong way as well. And so just avoiding those things, but also what I want people to do is support their microbiome by, you know, and this should be just Captain Obvious at this point. And me working at a university for so long as a strength and conditioning coach before I did my clinical work,

I work with people from all over the world and I would ask them about their fermented foods and every culture had something. Yeah. Right. So whether it was like some kind of kefir or like pickled, whatever. Right. And so making sure that we're getting at least, you know, every couple of days, get a serving in of some fermented food or beverage. Gotta eat the kimchi. Yeah. I got a jar in my fridge. I love kimchi. And my, my mother-in-law makes it for me and she's from Kenya. So they had like a fermented, um,

a fermented, like kind of similar to kombucha. Like she knew about this like 20 years ago. And I'm like, what is this weird stuff she's growing in the kitchen? It's freaking me out. She had grass, like first time I came to visit and they were growing grass, you know, like it was wheatgrass. But I was like, hey, why's your mom got grass in here? She'd get it. I didn't know. So anyways- Never got a grass. I didn't know. But that is a big component here is like,

shifting gears and having a more targeted perspective about supporting that gut microbiome, but also, and this is a really cool takeaway for everybody today, is making sure we're getting in servings of what I call good sleep nutrients every day. Yeah. What is that? Because eating first sleep, nobody really talks about that. So what does that look like? The first one I'd share, and this one is from the public library of science. And so they found that vitamin C, which we know about vitamin C, we tend to associate it with the immune system.

right? This powerful antioxidant. But they found that

that folks in this particular study that were deficient in vitamin C had a tendency towards waking up more frequently. And getting vitamin C levels elevated reversed their symptoms. So that's just one example. So- Iron is the other one. Do you have a little ferret? There's another one. Yeah. Oh my goodness. That's huge. And especially more so for women, it tends to be. And another one, this was published in the journal Sleep. This is the big journal.

And what they found was calcium, right? So this goes back to that story that I was told about calcium. It is important for sure. But folks who were deficient in calcium had more interrupted sleep patterns as well. And so by getting those calcium levels up, but how do we go about that? I'll just...

pass it over to you rather than drinking like homogenized glowing milk dark, you know, like from a mutant cow. Like what other sources of calcium do we add? Oh my God. You know, when you look at the data on calcium, it actually isn't as great as we thought for bones, but the best absorbability and use is actually from greens like arugula and greens that we can have dark green leafy vegetables. Also, there's some great sources like tahini, which is basically ground sesame seeds. Also different,

things people might like, I like, which is sardines with the bones in them and salmon with the bones in them, like canned salmon. Those are really great to eat because they have a lot of great absorbable calcium. Exactly. Calcium is kind of like an end product from this biological transmutation. So bones have a great source of it. People say, well, you need milk. I'm like, well, where do you think a cow gets their calcium from and has strong bones? Have you ever seen a cow bone? They eat grass. They should eat grass anyway. This is a really fascinating process. It's kind of like

like a biological transmutation of sorts where certain things come together to create bone, right? So like you need silica, you need- Boron. Boron, right? Vitamin K2, yeah. All of these things come together to make this magic happen. So, and by the way, I want to give some sources with vitamin C. Obviously we know about citrus, fruits like strawberries, sweet peppers,

but there are these quote superfoods as well, like camu camu berry. This might be the highest botanical source of vitamin C. Super tart, tangy fruit. It's like an Amazonian thing. Amla berry, acerola cherry. Those are super, super high sources of vitamin C. Another one, and this was, this is the last one I'll share. There's a whole list in Sleep Smarter. So this was a study conducted by University of Oxford found that omega-3s

can help folks to get deeper, more restful sleep. All right, so it helps with those modulating those rhythms, which it makes sense because it has to do with your brain. Right? Your brain has these gates. You know, you have the blood brain barrier, but the gate allows in certain VIPs. And it's only like 30 things, right? And one of those is a megathesis. Although you can have a leaky brain and then you get more trouble. Oh my goodness. You know about the leaky brain? This is like, you're already, you're getting into some territory here. This is super fascinating stuff, right? Yeah.

Leaky gut, leaky brain. Who knew? Yeah. Right? Who knew? So exciting. And also, there's some research that just came across that the brain...

kind of has its own immune system in a way. Yeah, it does. It has its own lymphatic system, which is like clean the brain every night. And guess how you do that? Sleeping. Yep. It's 10 times more active. Yeah. I mean, we know if you don't sleep, you're at much higher risk of Alzheimer's because you can't clear out the garbage and your brain gets toxic. It's fascinating. That's run by the glymphatic system. So that's like a little shout out to the glial cells that help to run it. The body is just incredible. So

Eat plenty of good sleep nutrients every day. Magnesium though? Oh, that was the last one actually. Okay. I was like, that's the first one I go to about patients. This is the big one. I was saving the best for last. I first learned about the benefits of magnesium probably from you. Okay. This was again, you've been talking about this for like 15 years. Yeah, I'm getting old. And I was like, holy crap.

because it's responsible for so many biochemical processes. - Oh my God, 300 enzymes and yeah. - And so what that means for people, it's just like, so magnesium is responsible for these, well now we know like over 325 processes. What that means is there are 325 things your body can't do or can't do properly when you're deficient on it. - Yeah, and by the way, magnesium deficiency affects 48% of Americans and it's caused by stress. - Chronic. - Yeah, chronic magnesium deficiency. It's caused by stress.

It's caused by coffee, alcohol, and not having enough in our diet, which comes from mostly plant foods, beans and greens, nuts and seeds. Yeah, absolutely. And this is one of the things that we can do something about. But like you said, it's kind of like an anti-stress mineral. Yeah. And so just the amount of stress that we're exposed...

Even our environment is stressful. It's different. We're indoors a lot more, processed air, and we're not getting access to sunlight. Just our reality is more stressful. But then put on top of that are work demands, relationship demands. How would you know if you're magnesium deficient?

You can get a test done, you know, but I really always- By the way, most of the tests are very inaccurate. Red cell magnesium is better, but it's mostly symptomatic. And actually the way we really have to diagnose it is called a magnesium load test, where you give people a high dose of IV magnesium, and then you collect the urine for 24 hours. And if nothing comes out, it means their body sucked it all up. And if it all comes out, it means they have enough. Right.

So I think, you know, magnesium testing is tricky. So you got to go by the symptoms. Exactly. Exactly. That's the thing. And what I was going to say is I always err on the side of how do you look, feel and perform, you know, and in my practice, there were only a couple supplements I would recommend. Magnesium was generally in maybe for 80% of the people that came in.

Because there's such a tendency for people to be deficient in it. But here's the issue. So food first, obviously. Anything green is going to be a good source of magnesium. So just keep that in mind. Kale, collard, mustard greens. But outside of that, supplementation can be tricky because we have this bowel tolerance. So even if you take a little bit more than your gut can handle at that moment, and you might need to really get your magnesium levels up, you're going to...

activate what we call clinically disaster pants, which means the poop, potentially pooping in your sleep. Yeah. Like the whole thing, this goes full circle. It's a laxative, milk and magnesia, right? Magnesium citrate is what they give people before they have colonoscopies to clean out their bowels, right? It works. So, and there's different forms and some are going to be better for different people. But what I, I don't know if you've done this or looked into this, but like topical magnesium. Yeah. You can use topical magnesium. Yeah. That's what I do. Even brought some with me when I travel, you know, keep it in my

um, in my back and I love it. I think it's fantastic. It's important. And people can, you know, overlook symptoms that are all caused by magnesium deficiency, right? Sleeplessness, insomnia, anxiety, palpitations, muscle cramps, menstrual cramps, seizures, you know, arrhythmias, palpitations, all those things are caused by magnesium deficiency. And it's interesting in medicine. We don't really think about it.

but it's used as a quote drug in the worst cases because drugs don't work. For example, preterm labor. Someone comes in having a baby too early. You give them intravenous magnesium. Someone comes in and they're having high blood pressure and seizures in pregnancy. They give them intravenous magnesium. People have

Cardiac arrhythmia is where their heart is beating crazy beats in the emergency room and none of the drugs work, you give them magnesium. It's pretty interesting and it's something we use all the time in medicine, but we don't think about it in this way, but it is probably one of the most powerful things for sleep for people.

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