Three Recommendations for Better Gut Health

In this week's episode, we dive into the fascinating world of gut health, including three actionable tips you can provide to patients. Explore the critical role of gut microbiome in health conditions ranging from autoimmune disorders to mental health to skin conditions.

The GameChanger
Health outcomes can be significantly impacted by addressing gut health issues through dietary modifications, understanding drug-nutrient depletions, and promoting the use of probiotics and prebiotics.
 
Guest
Anna Garrett, PharmD, BCPS
President, AnnaGarrett.com
 
Reference
How Gut Health Affects Your Whole Body

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CPE Information
 
Learning Objectives
Upon successful completion of this knowledge-based activity, participants should be able to:
1. Discuss the relationship between gut health and systemic conditions.
2. Identify strategies for assessing and addressing gut health issues, including dietary modifications, the use of probiotics and prebiotics, and the identification of drug-nutrient depletions.

0.05 CEU/0.5 Hr
UAN: 0107-0000-24-221-H01-P
Initial release date: 07/15/2024
Expiration date: 07/15/2025
Additional CPE details can be found here.

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Transcript

Speaker 1: 0:03

Hey, ce Plan members from CE Impact. This is Game Changers. I'm your host, jen Moulton, and a few weeks ago we talked with Dr Anna Garrett about perimenopause. We had a resounding response to that podcast. We were just talking about that before we got on here, and so we decided to invite her back to talk about another important topic gut health. Dr Garrett, I am super excited to have you back. Thank you so much for joining us. You're welcome and I'm happy to be back. Good, yes, we were just talking about that too. She was in Spain, I think, between the last podcast recording and this one, so that sounds amazing. I'm sure you had some great food. Speaking of gut health, some great food, some great wine. Yes, yeah, yeah, we won't talk. We won't speak more of that. I think we can all relate to that.

Speaker 2: 0:53

We will speak about it, but not in the way we want.

Speaker 1: 0:56

Yeah, right, right, not on this podcast, not recorded for all the time.

Speaker 1: 1:01

Well, gut health is a topic that has always been fascinating to me.

Speaker 1: 1:06

I think it's one of those things that really makes health care an art in addition to a science.

Speaker 1: 1:13

So you know we talk about, you know, evidence based, and you know I say that because I think there are things that are symptomatic, but sometimes we can't put true objective numbers, lab measures to it, and there's not a magic bullet, there's not a quick fix, and so it's easy to shy away from treating it or from helping to have patients have symptom relief. So I think you know it's not just gut health, but I think there's a lot of health conditions like that, and so, as pharmacists, I think there are really, really some ways that we can help patients identify these issues and be a solution for them and be a resource for them. So I think it's just a really great topic, and I guess we could start there if we could. Why? I think that gut health is something that you are increasingly hearing more and more about always heard about it, but I feel like increasingly I'm hearing it more mainstream. So why is there so much attention on gut health right now?

Speaker 2: 2:13

Well, it's sort of like perimenopause and menopause. It's having a moment right now, which is great. And you know, it's interesting because when I first started my functional medicine training, one of the first things we heard was all disease begins in the gut and I was like what Back up as I, as I went through and you know, completed the certification?

Speaker 2: 2:41

I don't know if all disease begins in the gut, but I'd say probably at least 80% does, if not more.

Speaker 2: 2:48

So there is this growing body of research that is showing the link between gut health and a variety of physical problems that we often would not think about, because, you know, typically as pharmacists or physicians or whatever, we think of bloating, reflux, those sorts of things, and it really is so much more than that.

Speaker 2: 3:13

So, like autoimmune diseases, like psoriasis and eczema, you think, well, it can't be related to the gut. But oh yes, it can, and so we've really just begun to scratch the surface of how the gut microbiome works. And the gut is home to like 70% of our immune system. So it's really important from that standpoint. And, in addition, somewhere between 50 and 80%, depending on which neurotransmitter you're talking about, are made in our gut. So that's that gut brain connection that we hear about, and if your gut health is poor and your neurotransmitter production is poor, well, it can cause all kinds of mental problems. So it really is fascinating how much of a link there is, and I'm really glad to see it coming to the forefront, because for so long at least you know, 10 years ago people would, you know, poo-poo the link between gut health and anything else.

Speaker 1: 4:18

No pun intended.

Speaker 2: 4:20

Yeah, exactly, and even like when it comes to hormone balance. I don't think I touched on this when we talked last, but if your gut health is poor, you start recirculating hormones, which makes them more toxic in some cases, and so you can't tease out gut health from everything else. It's again all interconnected.

Speaker 1: 4:42

Yeah, and it's so important to understand all of that before we can, you know, kind of go further to how? How do we address it? So you mentioned a couple, but what conditions is gut health linked to that we might not think about?

Speaker 2: 4:59

So the skin conditions that I mentioned and acne would be included in that, because that's more common than eczema and psoriasis. Obesity there's a potential link to dementia, mental health conditions, all sorts of autoimmune conditions, and really, with autoimmune problems, the first thing you do is address gut health, because autoimmune conditions are generally caused by a combination of poor diet, toxins and stress, with or without a genetic component. So then we have, you know, the common things that we think about the reflux, the diarrhea, the constipation, and then leaky gut, which was also poo-pooed, is not a thing, not a thing.

Speaker 1: 5:49

We must be listening to all the same stuff. Not a thing, exactly. And now?

Speaker 2: 5:53

we are finding out that it is indeed a thing, so it's just really interesting to watch the evolution of this as we go along.

Speaker 1: 6:03

Well, I think, kind of just in general, I think this is an area that pharmacists can really get involved in. I just, I just wrote about this, but I just watched the Blue Zones documentary and I had read that years and years ago. But I just watched the documentary and it just reminded me, you know, so much of it is. You know, you're just in Spain, so it's like the clean eating and the. You know all the things that we have in some of our food and we, you know, we wonder why disease is so prevalent and, yes, we're living longer. But you know there's all of that. But again, it's not the easy things like. It's not the easy things to do to. You know, we have such a convenient lifestyle here so it's not as easy to walk to the grocery store or, you know, get all your steps in or eat, you know, fresh foods. So I think it's again, you know we're always looking for that magic bullet. But so what are some of the common types of gut problems that you see in your functional medicine practice?

Speaker 2: 7:00

So I would say constipation and diarrhea are probably, probably constipation is tops on the list, or you know, somebody will tell me they have irritable bowel, which is going to be, you know, a combination of those two. I see a lot of reflux, I see a lot of leaky gut and then I see a lot of people that have autoimmune issues and so, like I said, they all kind of go together and as we go through midlife we're more likely to develop autoimmune conditions. Epidemic of thyroid disease, and the majority of this is in women and the majority of that is Hashimoto's. And the approach the initial approach to it is is different than if it's just garden variety hypothyroidism.

Speaker 1: 7:55

So you talk about leaky gut and you know, you hear about this and it is a thing, didn't used to be a thing. But how? How does that what? What do you mean by that? Cause I think when you say it, people are like oh, that's just a. You know, it's just a term that that they use to sell supplements or whatever it is yeah. And so what? What is it and why? Why does it matter?

Speaker 2: 8:18

Well, so it's also referred to as intestinal permeability. So the lining of your gut is actually only one cell thick and if you kind of visualize it as bricks and mortar, you've got the bricks and then you've got the mortar, and the mortar is the tight junctions which are supposed to stay tight. And when you encounter toxins or foods that you're sensitive to, or you have poor eating hygiene or your microbes get out of balance, that mortar can become loose and the bricks become loose. Toxins or partially digested food bacteria to leak out into your systemic circulation, which increases inflammation, which then in turn contributes to chronic disease. The inflammatory part so stress is a is a huge part of this. I swear if I could just get people to manage the stress, yeah me too, wouldn't that be great.

Speaker 1: 9:28

Easier said than done, I think all of our hormone problems would clear up and all of our gut problems would clear up.

Speaker 2: 9:35

But it's a major contributor because of the inflammation that it causes. It's a major contributor because of the inflammation that it causes.

Speaker 2: 9:44

You know, the increase in cortisol affects the immune system and the gut and slows down gut motility because you think you're having to run away from the tiger. Well, your body's not interested in digesting food if it thinks you're about to be killed or attacked by the tiger. And so it's all of these things that we just don't, we don't put two and two together about. Okay, what is my lifestyle contributing to this situation? And I try to get people to you know, really put their lifestyle under a microscope, as I term it, to see you know what, what needs to go, what is not a priority, and how do you take better care of yourself?

Speaker 1: 10:25

Yeah, which is again not the easy route.

Speaker 2: 10:30

That's the thing. It's like, yeah, can I just have a pill? I mean, this is how we got into the situation we're in with with PPIs. It's like, oh, this will make my stomach stop hurting. Well, it'll also make your bones break and possibly cause dementia and a whole bunch of and disrupt your gut health even more than it already is, because it creates a situation where H pylori can overgrow and then everything else is just kind of a cascade.

Speaker 1: 10:57

Yeah. So that's a really good point, cause I think we, you know, we talk about drug nutrient depletion, you know, being such a big part of functional medicine, and this is where I think pharmacists really can get so involved in. You know, it's not just dispensing the medications, but it's also looking at the whole picture and and just getting a better picture of that. So when, when we talk about drug nutrient depletion, like what are those big ones that you look for? And then what do you do about that? Like, what supplements are helpful for gut health to combat that, I know we don't want to like put a supplement in to do something different, but like- that's a whole nother podcast.

Speaker 1: 11:36

That's a whole nother conversation, right, but like, how do you kind of start to tackle it?

Speaker 2: 11:41

I guess, Well, so the biggest. There are three that just pop in my head right off the bat birth control pills, metformin and PPS. So you know, pps aren't prescription anymore and haven't been forever, and birth control pills, as a matter of fact, are not so much anymore either in some cases. But you know, if pharmacists could just talk about those three drugs every time they dispense it and what it depletes, that would be super helpful. So birth control pills depletes B vitamins, disrupts gut microbiome. So probiotics, a nice good quality B complex, can be really helpful for that.

Speaker 2: 12:24

Metformin, b12, ppis Now that's a whole laundry list of things. But you know, anytime you affect the stomach acid you're going to affect the ability to absorb all kinds of nutrients and the ability to break down protein and absorb amino acids. So you know, if I had to tell somebody what to supplement if they're going to take a PPI, it would of B vitamins so that in case there's a genetic issue, that they don't have to be activated. So there's just, there's a whole realm of drug nutrient interactions, but those three really popped to mind very quickly.

Speaker 1: 13:20

Yeah Well, and I think about particularly in community pharmacy, but also in the hospital, when you've got the med lists and you know you're kind of working through all that. I think it's so important to have just a couple in mind, three in mind in this case, because I think that is an issue that I've seen with some of these functional medicine conversations is, it's so much I don't know where to start, and I think that's true with patients too. You know, there's so many supplements and vitamins out there. I don't know where to start, so I'm just not going to do anything. So I, you know, I think it's hard because there there is a lot and there's a lot that you could do. But starting small, I think, maybe would then give us some confidence as pharmacists that each time I dispense this, I need to say did you know that this happens when you take it? And I would also recommend taking this with it. Yeah, so, starting small with those three things, that's, that's great.

Speaker 2: 14:12

Well, and helping people understand the impact of gluten and dairy. I mean, we haven't even talked about food sensitivities, but those are the well, let's go there, let's, let's talk about that.

Speaker 2: 14:22

So, um, you know, food sensitivities we sometimes might think of as allergies, but they're not true allergies, so it's just that your body can't handle it well. Um, and as we age and I'm talking about women, cause I don't, you know, work with men uh, we develop more food sensitivities, and so there are seven I'm not going to list off all seven, but I am going to get a drink of water but gluten, dairy and eggs are probably the three biggest ones. And so I, you know, you tell people I want you to go gluten free, and their eyes are like deer in the headlights yeah, can't do that. I can never give up bread. Well, you can. So what I? How I tend to present things like this is let's choose one, not both gluten and dairy at the same time. Let's do it as an experiment for a month. You can do anything for a month, basically, and I have had so many people get rid of joint pain and skin issues and abdominal pain just by getting rid of gluten. And a lot of people will say, well, I go to Europe and I eat gluten and I'm fine, I'm like, yeah, but their weed is not sprayed with all kinds of garbage. So you know, it's kind of a completely different animal. So I think as pharmacists, it's really helpful if we have the time to educate patients or, you know, clients for me.

Speaker 2: 15:58

But on the impact of food sensitivities, and so there are a lot of food sensitivity tests around. I don't tend to use those as like a first step because they can be expensive. You can get some false information from them. Like the first time I ever did one from them. Like the first time I ever did one, the thing that showed up highest was lettuce and I'm like well, I was like no. And the thing about food sensitivity testing is you have to actually be eating the thing for it to show up. So if you're gluten free and you take a test to see if you're sensitive to gluten, it's not going to show up because you're not eating it and your body has nothing to react to. But the sensitivities are important because they're a big contributor to intestinal permeability. So what I tend to do is just do an elimination diet with people and then add things back in stages.

Speaker 1: 16:58

Yeah, so when you say elimination diet, like how, how long do you suggest before they can tell that it's, that it's making a difference?

Speaker 2: 17:07

I you know, when I was in my training program they said do it for four months. I get some pushback on that from people. I find that if we do something for a month and they really are sensitive to it. They're going to experience positive results much faster than that.

Speaker 1: 17:26

Yeah, well, and I think too, there's just simple things you can cut out, so it's not all or nothing. I mean, when you talk about bread like sourdough they recommend, are there things that you can sort of help people ease into that? Because I think that's another barrier for people say, oh, I can't, I can't live without gluten, can't live that milk, can't you know, and so. But you could make you know different choices along the way that don't feel as as such a big deal.

Speaker 2: 17:53

So from a gluten sensitivity standpoint, it really kind of is an all or nothing thing if you're going to do the experiment. It really kind of is an all or nothing thing if you're going to do the experiment and gluten hides in things like shampoo and stuff, so you kind of have to go looking for it. So I give people a list of how gluten hides and what it's called. But you know, I eat gluten free for the most part because my partner has Crohn's disease and that's how he prefers to do it.

Speaker 2: 18:23

The gluten-free pastas now are actually really, really good, and there are some brands like, I mean, trader Joe's brown rice and quinoa spirals. I can't tell the difference, and so that is a very easy way to you know if you're a pasta lover to take a dip into it. The bread's a little more challenging, but honestly, I mean, there's a whole world of foods beyond those that can contain gluten, right, and so it's about getting people to see what they can eat instead of focusing on what they can't. Yeah, because it becomes a big, you know mind viral.

Speaker 1: 19:04

Right, right, Like when you say you want to be on a diet and then all of a sudden you eat everything in the house.

Speaker 2: 19:11

That's another podcast, yeah.

Speaker 1: 19:13

Well, another. This isn't a therapy session, Exactly. Oh, that's funny. So when you talk about supplements, you talked about what things are helpful for gut health. So those three, like those three medications for, or the medications you talked about with drug nutrient depletion, what supplements are also helpful for gut health? Just in general, if we're not looking at drug nutrient depletion?

Speaker 2: 19:38

So probiotics can be helpful Prebiotics and you can find combinations of both. The prebiotics actually feed your good gut bacteria. I prefer that people get those from foods. Actually, probiotics from foods are great too, so fermented foods. But some people don't like fermented foods, so like kombucha or like what do you mean yeah, or?

Speaker 2: 20:07

kefir or sauerkraut or you know any of those things, and some people love them. L-glutamine is a is a supplement that can be very soothing for the gut and so it doesn't taste like anything. You can mix it in water. It's also helpful for cravings if you sprinkle it on your tongue. So that's the bonus tip for today. And then if you've got microbial overgrowth, that's identified. So I do a stool test to identify that there are herbal antimicrobials. You don't necessarily have to go down the prescription road. You can actually treat H pylori with herbal products. And then there are mucilaginous herbs like slippery elm marshmallow root. There's a whole laundry list of those that are usually combined into like one supplement that are very soothing and healing for the gut.

Speaker 2: 21:02

But you know, really part of it is just the self care kinds of things you can do before you even get to supplements. So eating hygiene is super important, so chewing your food thoroughly, because digestion begins in your mouth. So if you're wolfing down your food, your body's going to have to work harder to break it down, and so that's important to make and to make sure you breathe while you eat, because there's a whole oxygen component to the digestive process. So there's a book called the Slow Down Diet, which has nothing to do with food choices and everything to do with the science of eating. That's a really easy read and very, very helpful if people want to understand more about the slowing down of the eating process. We talked about stress management. Avoiding NSAIDs that's a huge one. Avoiding antibiotics, if you can. Avoiding alcohol See, I told you come back up.

Speaker 2: 22:13

Because it's not very good for your gut. Lining and then increasing fiber is another thing that's easy to do. That can be very helpful for keeping things moving through.

Speaker 1: 22:18

Yeah, sometimes I think it's you know, some of this stuff is like okay, I know that, I know that, I know that, um, you have to have a why, you know, and so I think that's the, that's the real way that I think pharmacists can help um patients to have an impact. Um, is, you know, if this, then do this and you know, and so they have to have a reason to do it.

Speaker 1: 22:38

And again, small things, because if you try to do everything all at once too hard, but you know some of that health coaching you know, techniques that we talked through is you know, if this, then let's try this, let's do this this month, and you know, and then you get in the habits of doing some of those things.

Speaker 2: 22:55

So I think well, I just setting one tiny goal. Um, let's say, eat more fiber. So the average American, I think, eats like 20 grams of fiber a day, and you really need to be eating somewhere between 30 and 35 to really, you know, prevent constipation and just have overall good gut health, and that's not always easy to do. And so it's a matter of helping people figure out okay, how do I increase my fiber? And I think you know, if you're, if you're in a retail setting and you're super busy, well, obviously it's going to be a little challenging to do that, but you know what, if you had a patient handout that you could just, you know, give to somebody and do it that way? So, um, I, I have not worked retail for any more than just like filling in brief, briefly, and it was enough to tell me that that probably was not my best avenue. Uh, and I understand that the time constraints are very challenging.

Speaker 1: 23:55

So yeah, but I also think that community pharmacists are looking for more of that patient interaction and, you know, need some of the cash based services and you know those types of things. So I think it's a really. I think it's a really not I won't say easy, but it's a good way to dip your toe into that and, I think, to establish some of that trust with patients. And again, just going back to those three things, those three medications, every time we dispense those, start with that. I think that's a really great way to start. So, is there a point when patients or your clients need to see a doctor for gut issues? And what point would that be where, you know, maybe some of the supplements aren't helping, the diet changes aren't helping. You know what are some of the signs that you need to look for in order to refer patients?

Speaker 2: 24:45

So if you're having severe abdominal pain for, you know, more than 48 hours or so or if you're having pain that lasts more than a week, then you probably need to get that checked out. If you have severe bloating that's not helped by any of the dietary changes that we've talked about, it could be SIBO, small intestinal bowel overgrowth, which you know. I don't know if GI docs believe in that or not, but it is a thing. I have a whole book on it. Rectal bleeding should always be evaluated and then if you have black or bloody stools, again that should be checked out because that's another sign of bleeding. And then if you've got any unexplained weight loss so if you're not trying to lose weight and it's really coming off, you know that could be pancreatitis or it could be inflammatory bowel disease or it could be some sort of malignancy. So that is not something that you want to ignore, even though you know weight loss you may be like yay, I'm losing weight.

Speaker 2: 25:48

But you need to know why if it's not intentional?

Speaker 1: 25:52

Yeah, um, and I don't. Don't know. We didn't talk about this prior, but you know so many people are on GLP-1s to lose weight. And have you seen anything you know related to gut health? You know, I know those are some of the side effects with. You know some of the constipation or diarrhea, or you know intestinal cramping, some of that. So have you seen anything you know? What would you talk to patients about if they are taking a GLP-1? Or do we know yet?

Speaker 2: 26:20

You know, do we even know yet because they're so early? I think you know. One of the things that we do know is it causes a lot of muscle mass loss. So but from a gut standpoint, you know, I don't. I don't know how you get around slowing down the gi track when that's the actually the point of the medication, right? So if we try to circumvent that, are we just missing the point of the glp-1 um in general, what it does to gut micro balance? I don't think we know at this point.

Speaker 1: 26:54

Yeah yeah, something to keep an eye on for sure. Yeah yeah, well, this is super interesting and I think that, again, I think the biggest point is just starting small. You know, sort of understanding some of that drug nutrient depletion. You know what we're talking about with with GI issues, I think there are. So you know you hear so often the patients are with GI issues. I think there are, so you know you hear so often the patients are like, oh, I just don't know what's going on, I don't feel well, or you know I have acne, or you know whatever those things are, and I think so often we want to go to you know you need a medication for it, or you know you need to do this.

Speaker 1: 27:28

So I think this, these are such great topics on the preventive side. You know what can we do. You know what. What else can we look at first before we go to some of the medications? And then also, you know, just again, the, the preventive stuff and and marrying that with. You know if you're having issues yes, there's stuff that you know there you need to go to the doctor. There is more to be done with that.

Speaker 1: 27:55

And so just you know, kind of having your eye open, I think, to both sides of that I think is really important. I think functional medicine sometimes gets a bad route because people think, oh, it's just all about the food that we eat, and you know it's all or supplements, and it's really you know it's. It's such a balance, like we want to try to be healthy but then treat when needed.

Speaker 2: 28:15

Well, and what we've talked about today is definitely in our lane as pharmacists, to be able to do. Sometimes it feels like you can go a little too far afield, but this is definitely in our wheelhouse.

Speaker 1: 28:33

Yeah, absolutely Well, especially with the drug nutrient depletion. You know, we we need to be paying attention to that. We're the ones who are seeing it, so I think that's a really great point. Yeah, yeah, well, is there anything else that you want to say, kind of as a last last word?

Speaker 2: 28:51

Um, no, well, we didn't really talk about stool testing testing, but we don't really need to do that. If people want to know more about that, they can contact me and I'm happy to point them in the right direction.

Speaker 1: 29:03

Um because when you talk about stool testing, there's actually some information that you can gather in order to make recommendations yeah yeah, so that's that objective piece we're looking for.

Speaker 2: 29:15

Yeah, and I've offered it in my practice too, so you know, but there's there's several different ones out there and they all have their pluses and minuses, but it certainly is a good starting point. If somebody is not getting relief by doing some of the things that we've talked about today, that is a very logical next step. I mean again, it's the same thing I said, I think, when we were talking about perimenopause. It's like, you know, don't just suffer in silence and don't just let your patients suffer in silence. If you see that they keep getting all these GI medications, it might be time for a conversation and you know some adjunctive lifestyle things that could really benefit them.

Speaker 1: 29:59

Yeah, yeah, absolutely, and that's definitely in our wheelhouse.

Speaker 1: 30:03

Yeah yeah, well, I think one of our goals in having some of these conversations is to get pharmacists more comfortable, you know, with these conversations and with the supplements, and you know things that are available for you to consult on. You know, I think some of us who went to school maybe a while ago I'm not naming any names me, you know, we didn't get a lot of that, and so I think it's hard, you know, again, like we said, it's so big that sometimes you don't know where to start to learn about it. So I think gut health, as you said, relates to so many things, and so this is a, you know, maybe a good place to just, you know, to dip your toe in and to start learning. So thank you so much for this conversation today. I learned a lot and I, yeah, I've been, I've been through some of these you know, conversations about gut health, but, um, I think there's a few things that you said today that even I learned, so I appreciate it. Thanks, thanks for sharing your expertise. Uh, it's always a fun conversation, yeah.

Speaker 2: 31:08

Thank you for having me again.

Speaker 1: 31:09

Yeah, absolutely, um, and I don't think it'll be the last. So if you're, if you're open to my calls, hey, can we talk about this. So, thank you, thank you again, I appreciate it. And, and if you didn't listen to our episode on perimenopause, that is really a great one. And, you know, even though Dr Garrett's clientele is women, I mean men can benefit from this too. We all have women patients. So, you know, I hope people aren't listening just with their own hat on, but something that we can take to our practice. I think it's really important. Well, thank you again for being here. I appreciate it very much.

Speaker 1: 31:45

And if you, for our listeners, if you're a CE plan member, don't forget to claim your CE credit for this episode at CEimpactcom. And I have found lately I'll pass this on as a little tip that it is best if I claim my CE right away, because if I wait, I used to try to wait and kind of do it at the end of the month, and I would do four or five at a time. I always forget, so I think that is a good. It just two questions that you have to answer in order to get a half an hour of CE. So easy for that stuff to rack up pretty quickly, so I'd encourage you to do that. So, again, thank you for listening. Thank you, dr Garrett, for being here. I appreciate it and, as always, have a great week and keep learning.

Speaker 3: 32:35

Thanks for listening in. Claim your CE credit by clicking on the link in the show notes and check out CE Impact's other education at CEImpactcom, where we curate the most important information in pharmacy and medicine to deliver straight to you. Join today to connect your learning to practice.